Validation of the Cardiac Arrest Survival Score (CRASS) for Predicting Good Neurological Outcome after Out-of-Hospital Cardiac Arrest in an Asian Emergency Medical Service System

19 Pages Posted: 25 Jan 2022

See all articles by Nan Liu

Nan Liu

Duke-National University of Singapore Medical School - Centre for Quantitative Medicine

Jan Wnent

affiliation not provided to SSRN

Jin Wee Lee

National University of Singapore (NUS) - Duke-NUS Medical School

Yilin Ning

National University of Singapore (NUS) - Duke-NUS Medical School

Andrew Fu Wah Ho

National University of Singapore (NUS) - Duke-NUS Medical School

Fahad Javaid Siddiqui

National University of Singapore (NUS) - Duke-NUS Medical School

Shir Lynn Lim

National University of Singapore (NUS) - Department of Cardiology

Michael Yih-Chong Chia

Tan Tock Seng Hospital - Emergency Department

Ling Tiah

Changi General Hospital - Accident & Emergency

Desmond Ren-Hao Mao

Khoo Teck Puat Hospital - Department of Acute and Emergency Care

Jan-Thorsten Gräsner

affiliation not provided to SSRN

Marcus Eng Hock Ong

National University of Singapore (NUS) - Health Services and Systems Research; Singapore General Hospital - Department of Emergency Medicine

Abstract

Background: Survival with favourable neurological outcomes is an important indicator of successful resuscitation in out-of-hospital cardiac arrest (OHCA). We sought to validate the CaRdiac Arrest Survival Score (CRASS), derived using data from the German Resuscitation Registry, in predicting the likelihood of good neurological outcomes after OHCA in Singapore.

Methods: We conducted a retrospective population-based validation study among EMS-attended OHCA patients (≥18 years) in Singapore, using data from the prospective Pan-Asian Resuscitation Outcomes Study registry. Good neurological outcome was defined as a cerebral performance category of 1 or 2. To evaluate the CRASS score in light of the difference in patient characteristics, we used the default constant coefficient (0.8) and the adjusted coefficient (0.2) to calculate the probability of good neurological outcomes.

Results: Out of 11,404 analysed patients recruited between April 2010 and December 2018, 260 had good and 11,144 had poor neurological function. The CRASS score demonstrated good discrimination, with an area under the curve of 0.963 (95% confidence interval: 0.952-0.974). Using the default constant coefficient of 0.8, the CRASS score consistently overestimated the predicted probability of a good outcome. Following adjustment of the coefficient to 0.2, the CRASS score showed improved calibration.

Conclusion: CRASS demonstrated good discrimination and moderate calibration in predicting favourable neurological outcomes in the validation Singapore cohort. Our study established a good foundation for future large-scale, cross-country validations of the CRASS score in diverse sociocultural, geographical, and clinical settings.

Note:
Funding Information: This work was supported by the National Medical Research Council, Clinician Scientist Awards, Singapore (NMRC/CSA/024/2010, NMRC/CSA/0049/2013 and NMRC/CSA-SI/0014/2017) and Ministry of Health, Health Services Research Grant, Singapore (HSRG/0021/2012).

Declaration of Interests: MEH Ong reports funding from the Zoll Medical Corporation for a study involving mechanical cardiopulmonary resuscitation devices; grants from the Laerdal Foundation, Laerdal Medical, and Ramsey Social Justice Foundation for funding of the Pan-Asian Resuscitation Outcomes Study; an advisory relationship with Global Healthcare SG, a commercial entity that manufactures cooling devices; and funding from Laerdal Medical on an observation program to their Community CPR training Centre Research Program in Norway. MEH Ong has a licensing agreement and patent filed (Application no: 13/047,348) with ZOLL Medical Corporation for a study titled “Method of predicting acute cardiopulmonary events and survivability of a patient. He is also the co-founder and scientific advisor of TIIM Healthcare, a commercial entity which develops real-time prediction and risk stratification solutions at triage. All other authors have no conflict of interest to declare.

Ethics Approval Statement: The Centralised Institutional Review Board (2013/604/C and 2018/2937) and Domain Specific Review Board (C/10/545 and 2013/00929) granted approval for this study with a waiver of patient informed consent.

Keywords: Cardiac arrest, Survival, Score, Neurological outcome, Asia, Emergency medical service

Suggested Citation

Liu, Nan and Wnent, Jan and Lee, Jin Wee and Ning, Yilin and Ho, Andrew Fu Wah and Siddiqui, Fahad Javaid and Lim, Shir Lynn and Chia, Michael Yih-Chong and Tiah, Ling and Mao, Desmond Ren-Hao and Gräsner, Jan-Thorsten and Ong, Marcus Eng Hock, Validation of the Cardiac Arrest Survival Score (CRASS) for Predicting Good Neurological Outcome after Out-of-Hospital Cardiac Arrest in an Asian Emergency Medical Service System. Available at SSRN: https://ssrn.com/abstract=4017640

Nan Liu (Contact Author)

Duke-National University of Singapore Medical School - Centre for Quantitative Medicine ( email )

8 College Rd.
Singapore, 169857
Singapore
+65 6601 6503 (Phone)

Jan Wnent

affiliation not provided to SSRN ( email )

No Address Available

Jin Wee Lee

National University of Singapore (NUS) - Duke-NUS Medical School ( email )

Singapore
Singapore

Yilin Ning

National University of Singapore (NUS) - Duke-NUS Medical School ( email )

Singapore
Singapore

Andrew Fu Wah Ho

National University of Singapore (NUS) - Duke-NUS Medical School ( email )

Singapore
Singapore

Fahad Javaid Siddiqui

National University of Singapore (NUS) - Duke-NUS Medical School ( email )

Singapore
Singapore

Shir Lynn Lim

National University of Singapore (NUS) - Department of Cardiology ( email )

Singapore

Michael Yih-Chong Chia

Tan Tock Seng Hospital - Emergency Department ( email )

Ling Tiah

Changi General Hospital - Accident & Emergency ( email )

Desmond Ren-Hao Mao

Khoo Teck Puat Hospital - Department of Acute and Emergency Care ( email )

Jan-Thorsten Gräsner

affiliation not provided to SSRN ( email )

No Address Available

Marcus Eng Hock Ong

National University of Singapore (NUS) - Health Services and Systems Research ( email )

Singapore General Hospital - Department of Emergency Medicine ( email )

Singapore

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