https://scholars.lib.ntu.edu.tw/handle/123456789/534043
標題: | Predictive performance of universal termination of resuscitation rules in an Asian community: Are they accurate enough? | 作者: | WEN-CHU CHIANG PATRICK CHOW-IN KO Chang A.M. Liu S.S.-H. HUI-CHIH WANG CHIH-WEI YANG MING-JU HSIEH SHEY-YING CHEN Lai M.-S. MATTHEW HUEI-MING MA |
公開日期: | 2015 | 卷: | 32 | 期: | 4 | 起(迄)頁: | 318-323 | 來源出版物: | Emergency Medicine Journal | 摘要: | 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. ? 2015, BMJ Publishing Group. All rights reserved. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/534043 | ISSN: | 1472-0205 | DOI: | 10.1136/emermed-2013-203289 | SDG/關鍵字: | adult; advanced life support; aged; Article; Asia; basic life support; clinical evaluation; community; diagnostic accuracy; emergency care; emergency health service; female; health care quality; health care system; hospital discharge; human; major clinical study; male; mortality; out of hospital cardiac arrest; outcome assessment; overall survival; patient safety; patient transport; predictive value; priority journal; resuscitation; sensitivity and specificity; survivor; Taiwan; termination of resuscitation; validation study; decision support system; long term care; Out-of-Hospital Cardiac Arrest; practice guideline; register; resuscitation; standards; survival rate; treatment outcome; Aged; Cardiopulmonary Resuscitation; Decision Support Techniques; Emergency Medical Services; Female; Hospital Mortality; Humans; Life Support Care; Male; Medical Futility; Out-of-Hospital Cardiac Arrest; Practice Guidelines as Topic; Predictive Value of Tests; Registries; Survival Rate; Taiwan |
顯示於: | 醫學院附設醫院 (臺大醫院) |
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