Predictive performance of universal termination of resuscitation rules in an Asian community: Are they accurate enough?

Wen Chu Chiang, Patrick Chow In Ko, Anna Marie Chang, Sot Shih Hung Liu, Hui Chih Wang, Chih Wei Yang, Ming Ju Hsieh, Shey Ying Chen, Mei Shu Lai, Matthew Huei Ming Ma

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Introduction: Prehospital termination of resuscitation (TOR) rules have not been widely validated outside of Western countries. This study evaluated the performance of TOR rules in an Asian metropolitan with a mixed-tier emergency medical service (EMS). Methods: We analysed the Utstein registry of adult, non-traumatic out-of-hospital cardiac arrests (OHCAs) in Taipei to test the performance of TOR rules for advanced life support (ALS) or basic life support (BLS) providers. ALS and BLS-TOR rules were tested in OHCAs among three subgroups: (1) resuscitated by ALS, (2) by BLS and (3) by mixed ALS and BLS. Outcome definition was in-hospital death. Sensitivity, specificity, positive predictive value (PPV), negative predictive value and decreased transport rate (DTR) among various provider combinations were calculated. Results: Of the 3489 OHCAs included, 240 were resuscitated by ALS, 1727 by BLS and 1522 by ALS and BLS. Overall survival to hospital discharge was 197 patients (5.6%). Specificity and PPV of ALS-TOR and BLS-TOR for identifying death ranged from 70.7% to 81.8% and 95.1% to 98.1%, respectively. Applying the TOR rules would have a DTR of 34.2-63.9%. BLS rules had better predictive accuracy and DTR than ALS rules among all subgroups. Conclusions: Application of the ALS and BLS TOR rules would have decreased OHCA transported to the hospital, and BLS rules are reasonable as the universal criteria in a mixed-tier EMS. However, 1.9-4.9% of those who survived would be misclassified as non-survivors, raising concern of compromising patient safety for the implementation of the rules.

Original languageEnglish (US)
Pages (from-to)318-323
Number of pages6
JournalEmergency Medicine Journal
Volume32
Issue number4
DOIs
StatePublished - Apr 1 2015

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Resuscitation
Out-of-Hospital Cardiac Arrest
Emergency Medical Services
Value of Life
Patient Safety
Registries

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Emergency Medicine

Cite this

Chiang, W. C., Ko, P. C. I., Chang, A. M., Liu, S. S. H., Wang, H. C., Yang, C. W., ... Ma, M. H. M. (2015). Predictive performance of universal termination of resuscitation rules in an Asian community: Are they accurate enough? Emergency Medicine Journal, 32(4), 318-323. https://doi.org/10.1136/emermed-2013-203289

Predictive performance of universal termination of resuscitation rules in an Asian community : Are they accurate enough? / Chiang, Wen Chu; Ko, Patrick Chow In; Chang, Anna Marie; Liu, Sot Shih Hung; Wang, Hui Chih; Yang, Chih Wei; Hsieh, Ming Ju; Chen, Shey Ying; Lai, Mei Shu; Ma, Matthew Huei Ming.

In: Emergency Medicine Journal, Vol. 32, No. 4, 01.04.2015, p. 318-323.

Research output: Contribution to journalArticle

Chiang, WC, Ko, PCI, Chang, AM, Liu, SSH, Wang, HC, Yang, CW, Hsieh, MJ, Chen, SY, Lai, MS & Ma, MHM 2015, 'Predictive performance of universal termination of resuscitation rules in an Asian community: Are they accurate enough?', Emergency Medicine Journal, vol. 32, no. 4, pp. 318-323. https://doi.org/10.1136/emermed-2013-203289
Chiang, Wen Chu ; Ko, Patrick Chow In ; Chang, Anna Marie ; Liu, Sot Shih Hung ; Wang, Hui Chih ; Yang, Chih Wei ; Hsieh, Ming Ju ; Chen, Shey Ying ; Lai, Mei Shu ; Ma, Matthew Huei Ming. / Predictive performance of universal termination of resuscitation rules in an Asian community : Are they accurate enough?. In: Emergency Medicine Journal. 2015 ; Vol. 32, No. 4. pp. 318-323.
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abstract = "Introduction: Prehospital termination of resuscitation (TOR) rules have not been widely validated outside of Western countries. This study evaluated the performance of TOR rules in an Asian metropolitan with a mixed-tier emergency medical service (EMS). Methods: We analysed the Utstein registry of adult, non-traumatic out-of-hospital cardiac arrests (OHCAs) in Taipei to test the performance of TOR rules for advanced life support (ALS) or basic life support (BLS) providers. ALS and BLS-TOR rules were tested in OHCAs among three subgroups: (1) resuscitated by ALS, (2) by BLS and (3) by mixed ALS and BLS. Outcome definition was in-hospital death. Sensitivity, specificity, positive predictive value (PPV), negative predictive value and decreased transport rate (DTR) among various provider combinations were calculated. Results: Of the 3489 OHCAs included, 240 were resuscitated by ALS, 1727 by BLS and 1522 by ALS and BLS. Overall survival to hospital discharge was 197 patients (5.6{\%}). Specificity and PPV of ALS-TOR and BLS-TOR for identifying death ranged from 70.7{\%} to 81.8{\%} and 95.1{\%} to 98.1{\%}, respectively. Applying the TOR rules would have a DTR of 34.2-63.9{\%}. BLS rules had better predictive accuracy and DTR than ALS rules among all subgroups. Conclusions: Application of the ALS and BLS TOR rules would have decreased OHCA transported to the hospital, and BLS rules are reasonable as the universal criteria in a mixed-tier EMS. However, 1.9-4.9{\%} of those who survived would be misclassified as non-survivors, raising concern of compromising patient safety for the implementation of the rules.",
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T1 - Predictive performance of universal termination of resuscitation rules in an Asian community

T2 - Are they accurate enough?

AU - Chiang, Wen Chu

AU - Ko, Patrick Chow In

AU - Chang, Anna Marie

AU - Liu, Sot Shih Hung

AU - Wang, Hui Chih

AU - Yang, Chih Wei

AU - Hsieh, Ming Ju

AU - Chen, Shey Ying

AU - Lai, Mei Shu

AU - Ma, Matthew Huei Ming

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N2 - Introduction: Prehospital termination of resuscitation (TOR) rules have not been widely validated outside of Western countries. This study evaluated the performance of TOR rules in an Asian metropolitan with a mixed-tier emergency medical service (EMS). Methods: We analysed the Utstein registry of adult, non-traumatic out-of-hospital cardiac arrests (OHCAs) in Taipei to test the performance of TOR rules for advanced life support (ALS) or basic life support (BLS) providers. ALS and BLS-TOR rules were tested in OHCAs among three subgroups: (1) resuscitated by ALS, (2) by BLS and (3) by mixed ALS and BLS. Outcome definition was in-hospital death. Sensitivity, specificity, positive predictive value (PPV), negative predictive value and decreased transport rate (DTR) among various provider combinations were calculated. Results: Of the 3489 OHCAs included, 240 were resuscitated by ALS, 1727 by BLS and 1522 by ALS and BLS. Overall survival to hospital discharge was 197 patients (5.6%). Specificity and PPV of ALS-TOR and BLS-TOR for identifying death ranged from 70.7% to 81.8% and 95.1% to 98.1%, respectively. Applying the TOR rules would have a DTR of 34.2-63.9%. BLS rules had better predictive accuracy and DTR than ALS rules among all subgroups. Conclusions: Application of the ALS and BLS TOR rules would have decreased OHCA transported to the hospital, and BLS rules are reasonable as the universal criteria in a mixed-tier EMS. However, 1.9-4.9% of those who survived would be misclassified as non-survivors, raising concern of compromising patient safety for the implementation of the rules.

AB - Introduction: Prehospital termination of resuscitation (TOR) rules have not been widely validated outside of Western countries. This study evaluated the performance of TOR rules in an Asian metropolitan with a mixed-tier emergency medical service (EMS). Methods: We analysed the Utstein registry of adult, non-traumatic out-of-hospital cardiac arrests (OHCAs) in Taipei to test the performance of TOR rules for advanced life support (ALS) or basic life support (BLS) providers. ALS and BLS-TOR rules were tested in OHCAs among three subgroups: (1) resuscitated by ALS, (2) by BLS and (3) by mixed ALS and BLS. Outcome definition was in-hospital death. Sensitivity, specificity, positive predictive value (PPV), negative predictive value and decreased transport rate (DTR) among various provider combinations were calculated. Results: Of the 3489 OHCAs included, 240 were resuscitated by ALS, 1727 by BLS and 1522 by ALS and BLS. Overall survival to hospital discharge was 197 patients (5.6%). Specificity and PPV of ALS-TOR and BLS-TOR for identifying death ranged from 70.7% to 81.8% and 95.1% to 98.1%, respectively. Applying the TOR rules would have a DTR of 34.2-63.9%. BLS rules had better predictive accuracy and DTR than ALS rules among all subgroups. Conclusions: Application of the ALS and BLS TOR rules would have decreased OHCA transported to the hospital, and BLS rules are reasonable as the universal criteria in a mixed-tier EMS. However, 1.9-4.9% of those who survived would be misclassified as non-survivors, raising concern of compromising patient safety for the implementation of the rules.

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