Abstract
AimThe National Cardiac Arrest Audit (NCAA) is the UK national clinical audit for in-hospital cardiac arrest. To make fair comparisons among health care providers, clinical indicators require case mix adjustment using a validated risk model. The aim of this study was to develop and validate risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team in UK hospitals. MethodsRisk models for two outcomes—return of spontaneous circulation (ROSC) for greater than 20min and survival to hospital discharge—were developed and validated using data for in-hospital cardiac arrests between April 2011 and March 2013. For each outcome, a full model was fitted and then simplified by testing for non-linearity, combining categories and stepwise reduction. Finally, interactions between predictors were considered. Models were assessed for discrimination, calibration and accuracy. Results22,479 in-hospital cardiac arrests in 143 hospitals were included (14,688 development, 7791 validation). The final risk model for ROSC>20min included: age (non-linear), sex, prior length of stay in hospital, reason for attendance, location of arrest, presenting rhythm, and interactions between presenting rhythm and location of arrest. The model for hospital survival included the same predictors, excluding sex. Both models had acceptable performance across the range of measures, although discrimination for hospital mortality exceeded that for ROSC>20min (c index 0.81 versus 0.72). ConclusionsValidated risk models for ROSC>20min and hospital survival following in-hospital cardiac arrest have been developed. These models will strengthen comparative reporting in NCAA and support local quality improvement.
Highlights
National clinical audit has a key role to play in ensuring high quality clinical care.[1]
During this time there were a total of 28,987 resuscitation team visits following 2222 calls for cardiac arrest reported to National Cardiac Arrest Audit (NCAA)
Based on a relatively simple dataset, we have developed a risk model with good discrimination (c index > 0.8) for predicting survival to hospital discharge following an in-hospital cardiac arrest attended by a hospital-based resuscitation team
Summary
National clinical audit has a key role to play in ensuring high quality clinical care.[1]. NCAA monitors and reports on the incidence of, and outcome from, cardiac arrests attended by a hospital-based resuscitation team in order to inform practice and policy. It aims to identify deficiencies and foster improvements in the prevention, treatment and outcomes of in-hospital cardiac arrest. D.A. Harrison et al / Resuscitation 85 (2014) 993–1000 several audits and registries of in-hospital cardiac arrest have been established—most notably the American Heart Association’s ‘Get With The Guidelines–Resuscitation’ (GWTG-R) registry (formerly the National Registry of Cardiopulmonary Resuscitation), ongoing since 20004—the first validated risk model for outcome following in-hospital cardiac arrest was only published in 2013.5 this risk model, based on data from the United States, may not transfer well to different health care systems.[6,7,8]
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