External validation of the CRASS score for predicting good neurological outcome in out-of-hospital cardiac arrest: analysis from cardiac-origin and non-cardiac origin cohorts.
Journal
BMC Emergency Medicine
Journal Volume
26
Journal Issue
1
Start Page
Article number : 52
ISSN
1471-227X
Date Issued
2026-01-16
Author(s)
Chen, Ching-Yu
Kuo, Yi-Chien
Huang, Chun-Hsiang
Huang, Sih-Shiang
Huang, Chien-Tai
Ho, Yi-Ju
Lien, Chun-Ju
Abstract
Background: This study aimed to externally validate the CaRdiac Arrest Survival Score (CRASS) for predicting good neurological outcomes in Asian patients with out-of-hospital cardiac arrest (OHCA), focusing on cardiac-origin and noncardiac-origin cohorts, respectively. Methods: This multicenter retrospective cohort study, conducted from January 2016 to December 2023 across three hospitals in Taiwan, included patients with OHCA with resuscitation attempts, and excluded those with trauma-related arrests, pediatric cases, or missing data. The CRASS score was calculated for each patient according to the clinical variables at presentation. The outcome involves a good neurological outcome (Cerebral Performance Category (CPC) 1 or 2) at hospital discharge. Predictive performance was evaluated using the area under the receiver operating characteristic curve (AUROC), calibration plots, and other performance metrics, including sensitivity, specificity, and positive and negative predictive values. Results: This study analyzed 1,311 patients with OHCA (667 cardiac-origin and 644 noncardiac-origin). The AUROC for predicting good neurological outcomes was 0.770 (95% confidence interval [CI]: 0.733–0.807) in the cardiac-origin cohort compared with 0.729 (95% CI: 0.661–0.796) in the noncardiac-origin cohort. The CRASS score exhibited better predictive performance in patients with cardiac origin, with an optimal cut-off value of 1.45, thereby supporting more aggressive treatment. The score in patients with noncardiac origin was more effective in predicting poor neurological outcomes, with an optimal cut-off value of − 1.47, favoring life support withdrawal. Conclusions: The CRASS score is effective for predicting good neurological outcomes in patients with cardiac-origin OHCA but is more suited to guiding treatment withdrawal in noncardiac-origin cases. Clinical trial number: Not applicable.
Subjects
CRASS score
External validation
Neurological outcome
Out-of-hospital cardiac arrest
Prediction model
Publisher
BioMed Central Ltd
Type
journal article