Daily FOUR score assessment provides accurate prognosis of long-term outcome in out-of-hospital cardiac arrest

被引:19
|
作者
Weiss, N. [1 ,2 ]
Venot, M. [1 ,2 ]
Verdonk, F. [1 ,2 ]
Chardon, A. [1 ,2 ]
Le Guennec, L. [1 ,2 ]
Llerena, M. C. [1 ,2 ]
Raimbourg, Q. [1 ,2 ]
Taldir, G. [1 ,2 ]
Luque, Y. [1 ,2 ]
Fagon, J. -Y. [1 ,2 ]
Guerot, E. [1 ,2 ]
Diehl, J. -L. [1 ,2 ]
机构
[1] Georges Pompidou European Hosp, AP HP, Dept Crit Care Med, F-75908 Paris 15, France
[2] Univ Paris 05, F-75006 Paris, France
关键词
Coma; FOUR score; Glasgow Coma Scale; Prognostication; Cardiac arrest; INTENSIVE-CARE-UNIT; GLASGOW COMA SCORE; CEREBRAL ANOXIA; SCALE; PREDICTION; SURVIVORS; CARDIOPULMONARY; HYPOTHERMIA; VALIDATION;
D O I
10.1016/j.neurol.2015.02.013
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background. - The accurate prediction of outcome after out-of-hospital cardiac arrest (OHCA) is of major importance. The recently described Full Outline of UnResponsiveness (FOUR) is well adapted to mechanically ventilated patients and does not depend on verbal response. Objective. - To evaluate the ability of FOUR assessed by intensivists to accurately predict outcome in OHCA. Methods. - We prospectively identified patients admitted for OHCA with a Glasgow Coma Scale below 8. Neurological assessment was performed daily. Outcome was evaluated at 6 months using Glasgow-Pittsburgh Cerebral Performance Categories (GP-CPC). Results. - Eighty-five patients were included. At 6 months, 19 patients (22%) had a favorable outcome, GP-CPC 1-2, and 66 (78%) had an unfavorable outcome, GP-CPC 3-5. Compared to both brainstem responses at day 3 and evolution of Glasgow Coma Scale, evolution of FOUR score over the three first days was able to predict unfavorable outcome more precisely. Thus, absence of improvement or worsening from day 1 to day 3 of FOUR had 0.88 (0.79-0.97) specificity, 0.71 (0.66-0.76) sensitivity, 0.94(0.84-1.00) PPV and 0.54 (0.49-0.59) NPV to predict unfavorable outcome. Similarly, the brainstem response of FOUR score at 0 evaluated at day 3 had 0.94 (0.89-0.99) specificity, 0.60 (0.50-0.70) sensitivity, 0.96 (0.92-1.00) PPV and 0.47 (0.37-0.57) NPV to predict unfavorable outcome. Conclusion. - The absence of improvement or worsening from day 1 to day 3 of FOUR evaluated by intensivists provides an accurate prognosis of poor neurological outcome in OHCA. (C) 2015 Elsevier Masson SAS. All rights reserved.
引用
收藏
页码:437 / 444
页数:8
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