title: Adult "termination-of-resuscitation" (TOR)-criteria may not be suitable for children - a retrospective analysis.
abstract: BACKGROUND
  Only a small number of patients survive out-of-hospital-cardiac-arrest (OHCA). The duration of CPR varies considerably and transportation of patients under CPR is often unsuccessful. Termination-of-resuscitation (TOR)-criteria aim to preclude futile resuscitation efforts. Our goal was to find out to which extent existing TOR-criteria can be transferred to paediatric OHCA-patients with special regard to their prognostic value.
  
  
  METHODS
  We performed a retrospective analysis of an eleven-year single centre patient cohort. 43 paediatric patients admitted to our institution after emergency-medical-system (EMS)-confirmed OHCA from 2003 to 2013 were included. Morrison's BLS- and ALS-TOR-rules as well as the Trauma-TOR-criteria by the American Association of EMS Physicians were evaluated for application in children, by calculating sensitivity, specificity, negative and positive predictive value for death-, as well as survival-prediction in our cohort.
  
  
  RESULTS
  26 patients achieved ROSC and 14 were discharged alive (n = 7 PCPC 1/2, n = 7 PCPC 5). Sensitivity for BLS-TOR-criteria predicting death was 48.3%, specificity 92.9%, the PPV 93.3% and the NPV 46.4%. ALS-TOR-criteria for death had a sensitivity of 10.3%, specificity of 100%, a PPV of 100% and an NPV of 35%.
  
  
  CONCLUSIONS
  Retrospective application of the BLS-TOR-rule in our patient cohort identified the resuscitation of one later survivor as futile. ALS-TOR-criteria did not give false predictions of death. The proportion of CPRs that could have been abandoned is 48.2% for the BLS-TOR and only 10.3% for the ALS-TOR-rule. Both rules therefore appear not to be transferable to a paediatric population.
authors.affiliation: Klinik für Kinder- und Jugendmedizin, Sektion Neonatologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
authors.forename: Victoria Maria
authors.initials: VM
authors.lastname: Rotering
authors.affiliation: Klinik für Kinder- und Jugendmedizin, Sektion Neonatologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
authors.forename: Sonja
authors.initials: S
authors.lastname: Trepels-Kottek
authors.affiliation: Klinik für Kinder- und Jugendmedizin, Sektion Neonatologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
authors.forename: Konrad
authors.initials: K
authors.lastname: Heimann
authors.affiliation: Zentrale Notaufnahme, Uniklinik RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany.
authors.forename: Jörg-Christian
authors.initials: JC
authors.lastname: Brokmann
authors.affiliation: Klinik für Kinder- und Jugendmedizin, Sektion Neonatologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Orlikowsky
authors.affiliation: Klinik für Kinder- und Jugendmedizin, Sektion Neonatologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. mschoberer@ukaachen.de.
authors.forename: Mark
authors.initials: M
authors.lastname: Schoberer
mesh_terms: D002648:Child; D004632:Emergency Medical Services / Q000331:legislation & jurisprudence*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008020:Life Support Care / Q000379:methods*; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D012042:Registries; D016414:Resuscitation Orders / Q000331:legislation & jurisprudence*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
keywords: Cardiopulmonary resuscitation; End of life; Ethics; Out-of-hospital-cardiac-arrest; Out-of-hospital-resuscitation; Paediatric intensive care medicine; Termination-of-resuscitation