title: Neuroprognostication after pediatric cardiac arrest.
abstract: BACKGROUND
  Management decisions and parental counseling after pediatric cardiac arrest depend on the ability of physicians to make accurate and timely predictions regarding neurological recovery. We evaluated neurologists and intensivists performing neuroprognostication after cardiac arrest to determine prediction agreement, accuracy, and confidence.
  
  
  METHODS
  Pediatric neurologists (n = 10) and intensivists (n = 9) reviewed 18 cases of children successfully resuscitated from a cardiac arrest and managed in the pediatric intensive care unit. Cases were sequentially presented (after arrest day 1, days 2-4, and days 5-7), with updated examinations, neurophysiologic data, and neuroimaging data. At each time period, physicians predicted outcome by Pediatric Cerebral Performance Category and specified prediction confidence.
  
  
  RESULTS
  Predicted discharge Pediatric Cerebral Performance Category versus actual hospital discharge Pediatric Cerebral Performance Category outcomes were compared. Exact (Predicted Pediatric Cerebral Performance Category - Actual Pediatric Cerebral Performance Category = 0) and close (Predicted Pediatric Cerebral Performance Category - Actual Pediatric Cerebral Performance Category = ±1) outcome prediction accuracies for all physicians improved over successive periods (P < 0.05). Prediction accuracy did not differ significantly between physician groups at any period or overall. Agreement improved over time among neurologists (day 1 Kappa [κ], 0.28; days 2-4 κ, 0.43; days 5-7 κ, 0.68) and among intensivists (day 1 κ, 0.30; days 2-4 κ, 0.44; days 5-7 κ, 0.57). Prediction confidence increased over time (P < 0.001) and did not differ between physician groups.
  
  
  CONCLUSIONS
  Inter-rater agreement among neurologists and among intensivists improved over time and reached moderate levels. For all physicians, prediction accuracy and confidence improved over time. Further prospective research is needed to better characterize how physicians objectively and subjectively estimate neurological recovery after acute brain injury.
authors.affiliation: Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: kirschenm@chop.edu.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Kirschen
authors.affiliation: Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Alexis A
authors.initials: AA
authors.lastname: Topjian
authors.affiliation: Westat Biostatistics and Data Management Core, The Children's Hospital of Philadelphia.
authors.forename: Rachel
authors.initials: R
authors.lastname: Hammond
authors.affiliation: National Core for Neuroethics, Division of Neurology, Department of Medicine, The University of British Columbia.
authors.forename: Judy
authors.initials: J
authors.lastname: Illes
authors.affiliation: Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Abend
mesh_terms: D002675:Child, Preschool; D005260:Female; D006323:Heart Arrest / Q000150:complications*; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology*; D010820:Physicians / Q000523:psychology; D011237:Predictive Value of Tests; D011379:Prognosis; D013997:Time Factors
keywords: neuroprognostication; outcome prediction; pediatric cardiac arrest