title: Predictive performance of universal termination of resuscitation rules in an Asian community: are they accurate enough?
abstract: BACKGROUND
  Prehospital termination of resuscitation (TOR) rules have not been widely validated outside of Western countries. This study evaluated the performance of TOR rules in an Asian metropolitan with a mixed-tier emergency medical service (EMS).
  
  
  METHODS
  We analysed the Utstein registry of adult, non-traumatic out-of-hospital cardiac arrests (OHCAs) in Taipei to test the performance of TOR rules for advanced life support (ALS) or basic life support (BLS) providers. ALS and BLS-TOR rules were tested in OHCAs among three subgroups: (1) resuscitated by ALS, (2) by BLS and (3) by mixed ALS and BLS. Outcome definition was in-hospital death. Sensitivity, specificity, positive predictive value (PPV), negative predictive value and decreased transport rate (DTR) among various provider combinations were calculated.
  
  
  RESULTS
  Of the 3489 OHCAs included, 240 were resuscitated by ALS, 1727 by BLS and 1522 by ALS and BLS. Overall survival to hospital discharge was 197 patients (5.6%). Specificity and PPV of ALS-TOR and BLS-TOR for identifying death ranged from 70.7% to 81.8% and 95.1% to 98.1%, respectively. Applying the TOR rules would have a DTR of 34.2-63.9%. BLS rules had better predictive accuracy and DTR than ALS rules among all subgroups.
  
  
  CONCLUSIONS
  Application of the ALS and BLS TOR rules would have decreased OHCA transported to the hospital, and BLS rules are reasonable as the universal criteria in a mixed-tier EMS. However, 1.9-4.9% of those who survived would be misclassified as non-survivors, raising concern of compromising patient safety for the implementation of the rules.
authors: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan.
authors: Wen-Chu
authors: WC
authors: Chiang
authors: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan.
authors: Patrick Chow-In
authors: PC
authors: Ko
authors: Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon, USA.
authors: Anna Marie
authors: AM
authors: Chang
authors: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Sot Shih-Hung
authors: SS
authors: Liu
authors: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Hui-Chih
authors: HC
authors: Wang
authors: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan.
authors: Chih-Wei
authors: CW
authors: Yang
authors: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan.
authors: Ming-Ju
authors: MJ
authors: Hsieh
authors: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan.
authors: Shey-Ying
authors: SY
authors: Chen
authors: Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan.
authors: Mei-Shu
authors: MS
authors: Lai
authors: Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Matthew Huei-Ming
authors: MH
authors: Ma
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D003661:Decision Support Techniques; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008020:Life Support Care / Q000592:standards*; D008297:Male; D018447:Medical Futility; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012042:Registries; D015996:Survival Rate; D013624:Taiwan
keywords: cardiac arrest; emergency ambulance systems; prehospital care; resuscitation