Early findings on brain computed tomography and the prognosis of post-cardiac arrest syndrome: application of the score for stroke patients.
OBJECTIVE
To examine whether early findings of the brain computed tomography (CT) evaluated by the modified Alberta stroke programme early CT (m-ASPECT) score is useful for determining the prognosis of post-cardiac arrest syndrome (PCAS) patients or not.


METHODS
From 2003 through 2010, 149 consecutive PCAS patients: (1) with various aetiologies but neither from haemorrhagic stroke nor trauma, (2) who were 15 years old or older and (3) whose brain CT was available were admitted to our intensive care unit. Early findings on all of their CT images were rated with the m-ASPECT scoring system by three raters, and an inter-rater comparison was conducted. Next, the images within 24 h from arrest were collected from 133 patients (89 males, age 60.2±17.6 years), and a relation of the scores with outcome at day 30 of the patients was analysed.


RESULTS
According to the inter-rater comparison based on a linear regression analysis, agreement between the raters was good (correlation coefficient 0.76-0.88). A receiver operating curve analysis revealed that the m-ASPECT scores within 24 h were a good predictor of poor outcome (dead or vegetative state) with an area under the curve of 0.905. An m-ASPECT score ≤13 was 100% predictive of a poor outcome, with a negative predictive value of 0.57. The m-ASPECT score was the best predictor of poor outcome (odds ratio 45.62) among various factors including cause or duration of arrest.


CONCLUSIONS
The m-APSECT score evaluated within 24 h from arrest was found to be the most predictive factor for outcome at day 30.
Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan. sugimori@intmed2.med.kyushu-u.ac.jp
Hiroshi
H
Sugimori
Tomoo
T
Kanna
Koji
K
Yamashita
Takahiro
T
Kuwashiro
Takashi
T
Yoshiura
Akinori
A
Zaitsu
Makoto
M
Hashizume
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D007362:Intensive Care Units; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000000981:diagnostic imaging / Q000209:etiology; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult