Development and validation of risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team.
OBJECTIVE
The National Cardiac Arrest Audit (NCAA) is the UK national clinical audit for in-hospital cardiac arrest. To make fair comparisons among health care providers, clinical indicators require case mix adjustment using a validated risk model. The aim of this study was to develop and validate risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team in UK hospitals.


METHODS
Risk models for two outcomes-return of spontaneous circulation (ROSC) for greater than 20min and survival to hospital discharge-were developed and validated using data for in-hospital cardiac arrests between April 2011 and March 2013. For each outcome, a full model was fitted and then simplified by testing for non-linearity, combining categories and stepwise reduction. Finally, interactions between predictors were considered. Models were assessed for discrimination, calibration and accuracy.


RESULTS
22,479 in-hospital cardiac arrests in 143 hospitals were included (14,688 development, 7791 validation). The final risk model for ROSC>20min included: age (non-linear), sex, prior length of stay in hospital, reason for attendance, location of arrest, presenting rhythm, and interactions between presenting rhythm and location of arrest. The model for hospital survival included the same predictors, excluding sex. Both models had acceptable performance across the range of measures, although discrimination for hospital mortality exceeded that for ROSC>20min (c index 0.81 versus 0.72).


CONCLUSIONS
Validated risk models for ROSC>20min and hospital survival following in-hospital cardiac arrest have been developed. These models will strengthen comparative reporting in NCAA and support local quality improvement.
Intensive Care National Audit & Research Centre (ICNARC), Napier House, 24 High Holborn, London WC1V 6AZ, UK. Electronic address: david.harrison@icnarc.org.
David A
DA
Harrison
Intensive Care National Audit & Research Centre (ICNARC), Napier House, 24 High Holborn, London WC1V 6AZ, UK.
Krishna
K
Patel
Intensive Care National Audit & Research Centre (ICNARC), Napier House, 24 High Holborn, London WC1V 6AZ, UK.
Edel
E
Nixon
Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK.
Jasmeet
J
Soar
The School of Health and Social Care, University of Bournemouth, Bournemouth, UK.
Gary B
GB
Smith
Department of Anaesthesia, Salford Royal Hospital, Salford, UK.
Carl
C
Gwinnutt
Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK.
Jerry P
JP
Nolan
Intensive Care National Audit & Research Centre (ICNARC), Napier House, 24 High Holborn, London WC1V 6AZ, UK.
Kathryn M
KM
Rowan
D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends; D057209:Hospital Rapid Response Team; D006801:Humans; D008297:Male; D011379:Prognosis; D058996:Quality Improvement; D018570:Risk Assessment / Q000379:methods*; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
Cardiopulmonary resuscitation; Heart arrest; Hospital mortality; Models; Risk adjustment; Statistical