title: Predicting Survival with Good Neurological Outcome Within 24 Hours Following Out of Hospital Cardiac Arrest:The Application and Validation of a Novel Clinical Score.
abstract: BACKGROUND
  Despite 50 years of research, prognostication post cardiac arrest traditionally occurs at 72 hours. We tested the accuracy of a novel bedside score within 24 hours of hospital admission, in predicting neurologically intact survival.
  
  
  METHODS
  We studied 192 adults following non-traumatic out-of-hospital cardiac arrest. In a 50% random modeling sample, a model for survival to discharge with good neurological outcome was developed using univariate analysis and stepwise multivariate logistic regression for predictor selection. The diagnostic efficiency of this modeled score was assessed in the remaining 50% sample using receiver operating characteristic (ROC) analysis.
  
  
  RESULTS
  In this study, 20% of patients survived to discharge with good neurological outcome. The final logistic regression model in the modeling sample retained three predictors: initial rhythm Ventricular Fibrillation, Return of Spontaneous Circulation ≤ 20 minutes from collapse, and Brainstem Reflex Score ≥ 3 within 24 hours. These variables were used to develop a three-point Out of Hospital Cardiac Arrest score. The area under the (ROC) curve was 0.84 [95% CI, 0.75-0.93] in the modeling sample and 0.92 [95% CI, 0.87-0.98] in the validation sample. A score ≥ 2 predicted good neurological outcome with a sensitivity of 79%, a specificity of 92%, and a negative predictive value of 93%. A score ≥1 had a sensitivity of 100% and a negative predictive value of 100%; however, the specificity was only 55%.
  
  
  CONCLUSIONS
  This study demonstrates that a score based on clinical and easily accessible variables within 24 hours can predict neurologically intact survival following cardiac arrest.
authors: Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors: Aiham
authors: A
authors: Albaeni
authors: Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors: Shaker M
authors: SM
authors: Eid
authors: Division of Cardiology, Johns Hopkins Bayview Medical Center, USA.
authors: Dhananjay
authors: D
authors: Vaidya
authors: Nisha
authors: N
authors: Chandra-Strobos
keywords: Cardiopulmonary resuscitation; Heart arrest; Prognosis; Sudden death; Survival