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Education, Teaching, and Quality Improvement |

Comparison of Different ICU Scoring System to Predict Primary and Secondary Outcomes in Out of Hospital and In-House Cardiac Arrest Patients

Leena Gupta, MD; Kashif Hassan, MD
Author and Funding Information

Geisinger Medical Center, Danville, PA


Chest. 2013;144(4_MeetingAbstracts):565A. doi:10.1378/chest.1705366
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Abstract

SESSION TITLE: Outcomes/Quality Control Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Out of Hospital Cardiac Arrest (OHCA) and In-house Cardiac Arrest (IHCA) still has a very high mortality. Since the introduction of scoring systems in the 1980's, a variety of different scoring models has been developed for the intensive care unit (ICU) to predict prognosis. There are different ICU Scoring systems but which one is best able to predict the mortality and Neurological morbidity of the patients remains unanswered. The aim of this study was to assess the performance of the four major ICU predictive scoring systems. They are the Acute Physiologic and Chronic Health Evaluation (APACHE) scoring system, Simplified Acute Physiologic Score (SAPS), Mortality Prediction Model (MPM), and Sequential Organ Failure Assessment (SOFA)

METHODS: This is a retrospective study of cardiac arrest patients in a large community hospital. Acute Physiology and Chronic Health Evaluation (APACHE) IV, were computed and compared to other validated prognostic prediction tools like APACHE II, SAPS, MPM and SOFA score in OHCA and IHCA patients. We collected all cardiac arrest patients (304 patients) from 2009-2012 who arrived in the ER as OHCA and IHCA.

RESULTS: The median downtime was calculated and the initial rhythm were noted. The in-hospital mortality was 48% (147/304). The ICU scores were computed at time zero for OHCA and at time zero and at the time of arrest for IHCA patients. They were then correlated with the discharge diagnosis of these patients. Primary outcome measure was Intensive Care Unit mortality at 30, 60 and 90 days and Secondary outcome measure was neurological morbidity based on CPC score. The newer scoring systems performed significantly better than their older counterparts and were more accurate in predicting OHCA and IHCA mortality as well as morbidity.

CONCLUSIONS: Overall, APACHE IV scores were more accurate in predicting OHCA and IHCA morbidity and mortality

CLINICAL IMPLICATIONS: ICUs should be encouraged to have an inbuilt system to compute APACHE IV score when the patient arrives. This may help physicians to make better judgment for use of ICU resources.

DISCLOSURE: The following authors have nothing to disclose: Leena Gupta, Kashif Hassan

No Product/Research Disclosure Information


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