Performance of a simplified termination of resuscitation rule for adult traumatic cardiopulmonary arrest in the prehospital setting

Wen Chu Chiang, Yu Sheng Huang, Shu Hsien Hsu, Anna Marie Chang, Patrick Chow In Ko, Hui Chih Wang, Chih Wei Yang, Ming Ju Hsieh, Edward Pei Chuan Huang, Kah Meng Chong, Jen Tang Sun, Shey Ying Chen, Matthew Huei Ming Ma

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective The prehospital termination of resuscitation (TOR) guidelines for traumatic cardiopulmonary arrest (TCPA) was proposed in 2003. Its multiple descriptors of cases where efforts can be terminated make it complex to apply in the field. Here we proposed a simplified rule and evaluated its predictive performance. Methods We analysed Utstein registry data for 2009-2013 from a Taipei emergency medical service to test a simplified TOR rule that comprises two criteria: blunt trauma injury and the presence of asystole. Enrolees were adults (≥18 years) with TCPA. The predicted outcome was in-hospital death. We compared the areas under the curve (AUC) of the simple rule with each of four descriptors in the guidelines and with a combination of all four to assess their discriminatory ability. Test characteristics were calculated to assess predictive performance. Results A total of 893 TCPA cases were included. Blunt trauma occurred in 459 (51.4%) cases and asystole in 384 (43.0%). In-hospital mortality was 854 (95.6%) cases. The simplified TOR rule had greater discriminatory ability (AUC 0.683, 95% CI 0.618 to 0.747) compared with any single descriptor in the 2003 guidelines (range of AUC: 0.506-0.616) although the AUC was similar when all four were combined (AUC 0.695, 95% CI 0.615 to 0.775). The specificity of the simplified rule was 100% (95% CI 88.8% to 100%) and positive predictive value 100% (95% CI 96.8% to 100%). The false positive value, false negative value and decreased rate of unnecessary transport were 0% (95% CI 0% to 3.2%), 94.8% (95% CI 92.9% to 96.2%) and 16.4% (95% CI 14.1% to 19.1%), respectively. Conclusions The simplified TOR rule appears to accurately predict non-survivors in adults with TCPA in the prehospital setting.

Original languageEnglish (US)
JournalEmergency Medicine Journal
DOIs
StateAccepted/In press - Sep 21 2016
Externally publishedYes

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Heart Arrest
Resuscitation
Area Under Curve
Guidelines
Nonpenetrating Wounds
Wounds and Injuries
Emergency Medical Services
Hospital Mortality
Registries

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Performance of a simplified termination of resuscitation rule for adult traumatic cardiopulmonary arrest in the prehospital setting. / Chiang, Wen Chu; Huang, Yu Sheng; Hsu, Shu Hsien; Chang, Anna Marie; Ko, Patrick Chow In; Wang, Hui Chih; Yang, Chih Wei; Hsieh, Ming Ju; Huang, Edward Pei Chuan; Chong, Kah Meng; Sun, Jen Tang; Chen, Shey Ying; Ma, Matthew Huei Ming.

In: Emergency Medicine Journal, 21.09.2016.

Research output: Contribution to journalArticle

Chiang, WC, Huang, YS, Hsu, SH, Chang, AM, Ko, PCI, Wang, HC, Yang, CW, Hsieh, MJ, Huang, EPC, Chong, KM, Sun, JT, Chen, SY & Ma, MHM 2016, 'Performance of a simplified termination of resuscitation rule for adult traumatic cardiopulmonary arrest in the prehospital setting', Emergency Medicine Journal. https://doi.org/10.1136/emermed-2014-204493
Chiang, Wen Chu ; Huang, Yu Sheng ; Hsu, Shu Hsien ; Chang, Anna Marie ; Ko, Patrick Chow In ; Wang, Hui Chih ; Yang, Chih Wei ; Hsieh, Ming Ju ; Huang, Edward Pei Chuan ; Chong, Kah Meng ; Sun, Jen Tang ; Chen, Shey Ying ; Ma, Matthew Huei Ming. / Performance of a simplified termination of resuscitation rule for adult traumatic cardiopulmonary arrest in the prehospital setting. In: Emergency Medicine Journal. 2016.
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abstract = "Objective The prehospital termination of resuscitation (TOR) guidelines for traumatic cardiopulmonary arrest (TCPA) was proposed in 2003. Its multiple descriptors of cases where efforts can be terminated make it complex to apply in the field. Here we proposed a simplified rule and evaluated its predictive performance. Methods We analysed Utstein registry data for 2009-2013 from a Taipei emergency medical service to test a simplified TOR rule that comprises two criteria: blunt trauma injury and the presence of asystole. Enrolees were adults (≥18 years) with TCPA. The predicted outcome was in-hospital death. We compared the areas under the curve (AUC) of the simple rule with each of four descriptors in the guidelines and with a combination of all four to assess their discriminatory ability. Test characteristics were calculated to assess predictive performance. Results A total of 893 TCPA cases were included. Blunt trauma occurred in 459 (51.4{\%}) cases and asystole in 384 (43.0{\%}). In-hospital mortality was 854 (95.6{\%}) cases. The simplified TOR rule had greater discriminatory ability (AUC 0.683, 95{\%} CI 0.618 to 0.747) compared with any single descriptor in the 2003 guidelines (range of AUC: 0.506-0.616) although the AUC was similar when all four were combined (AUC 0.695, 95{\%} CI 0.615 to 0.775). The specificity of the simplified rule was 100{\%} (95{\%} CI 88.8{\%} to 100{\%}) and positive predictive value 100{\%} (95{\%} CI 96.8{\%} to 100{\%}). The false positive value, false negative value and decreased rate of unnecessary transport were 0{\%} (95{\%} CI 0{\%} to 3.2{\%}), 94.8{\%} (95{\%} CI 92.9{\%} to 96.2{\%}) and 16.4{\%} (95{\%} CI 14.1{\%} to 19.1{\%}), respectively. Conclusions The simplified TOR rule appears to accurately predict non-survivors in adults with TCPA in the prehospital setting.",
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AU - Chiang, Wen Chu

AU - Huang, Yu Sheng

AU - Hsu, Shu Hsien

AU - Chang, Anna Marie

AU - Ko, Patrick Chow In

AU - Wang, Hui Chih

AU - Yang, Chih Wei

AU - Hsieh, Ming Ju

AU - Huang, Edward Pei Chuan

AU - Chong, Kah Meng

AU - Sun, Jen Tang

AU - Chen, Shey Ying

AU - Ma, Matthew Huei Ming

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N2 - Objective The prehospital termination of resuscitation (TOR) guidelines for traumatic cardiopulmonary arrest (TCPA) was proposed in 2003. Its multiple descriptors of cases where efforts can be terminated make it complex to apply in the field. Here we proposed a simplified rule and evaluated its predictive performance. Methods We analysed Utstein registry data for 2009-2013 from a Taipei emergency medical service to test a simplified TOR rule that comprises two criteria: blunt trauma injury and the presence of asystole. Enrolees were adults (≥18 years) with TCPA. The predicted outcome was in-hospital death. We compared the areas under the curve (AUC) of the simple rule with each of four descriptors in the guidelines and with a combination of all four to assess their discriminatory ability. Test characteristics were calculated to assess predictive performance. Results A total of 893 TCPA cases were included. Blunt trauma occurred in 459 (51.4%) cases and asystole in 384 (43.0%). In-hospital mortality was 854 (95.6%) cases. The simplified TOR rule had greater discriminatory ability (AUC 0.683, 95% CI 0.618 to 0.747) compared with any single descriptor in the 2003 guidelines (range of AUC: 0.506-0.616) although the AUC was similar when all four were combined (AUC 0.695, 95% CI 0.615 to 0.775). The specificity of the simplified rule was 100% (95% CI 88.8% to 100%) and positive predictive value 100% (95% CI 96.8% to 100%). The false positive value, false negative value and decreased rate of unnecessary transport were 0% (95% CI 0% to 3.2%), 94.8% (95% CI 92.9% to 96.2%) and 16.4% (95% CI 14.1% to 19.1%), respectively. Conclusions The simplified TOR rule appears to accurately predict non-survivors in adults with TCPA in the prehospital setting.

AB - Objective The prehospital termination of resuscitation (TOR) guidelines for traumatic cardiopulmonary arrest (TCPA) was proposed in 2003. Its multiple descriptors of cases where efforts can be terminated make it complex to apply in the field. Here we proposed a simplified rule and evaluated its predictive performance. Methods We analysed Utstein registry data for 2009-2013 from a Taipei emergency medical service to test a simplified TOR rule that comprises two criteria: blunt trauma injury and the presence of asystole. Enrolees were adults (≥18 years) with TCPA. The predicted outcome was in-hospital death. We compared the areas under the curve (AUC) of the simple rule with each of four descriptors in the guidelines and with a combination of all four to assess their discriminatory ability. Test characteristics were calculated to assess predictive performance. Results A total of 893 TCPA cases were included. Blunt trauma occurred in 459 (51.4%) cases and asystole in 384 (43.0%). In-hospital mortality was 854 (95.6%) cases. The simplified TOR rule had greater discriminatory ability (AUC 0.683, 95% CI 0.618 to 0.747) compared with any single descriptor in the 2003 guidelines (range of AUC: 0.506-0.616) although the AUC was similar when all four were combined (AUC 0.695, 95% CI 0.615 to 0.775). The specificity of the simplified rule was 100% (95% CI 88.8% to 100%) and positive predictive value 100% (95% CI 96.8% to 100%). The false positive value, false negative value and decreased rate of unnecessary transport were 0% (95% CI 0% to 3.2%), 94.8% (95% CI 92.9% to 96.2%) and 16.4% (95% CI 14.1% to 19.1%), respectively. Conclusions The simplified TOR rule appears to accurately predict non-survivors in adults with TCPA in the prehospital setting.

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