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Development and Validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) Score to Predict Neurologically Intact Survival After In-Hospital Cardiopulmonary Resuscitation
Study Questions:
What is the validity of a simple prearrest point score for prediction of survival to discharge with good neurologic status for patients with in-hospital cardiac arrest (IHCA)?
Methods:
The study included 51,240 inpatients experiencing an index episode of in-hospital cardiac arrest (IHCA) between January 1, 2007, and December 31, 2009, in 366 hospitals participating in the Get With the Guidelines–Resuscitation registry. Dividing data into training (44.4%), test (22.2%), and validation (33.4%) data sets, the authors used multivariate methods to select the best independent predictors of good neurologic outcome, created a series of candidate decision models, and used the test data set to select the model that best classified patients as having a very low (<1%), low (1%-3%), average (>3%-15%), or higher than average (>15%) likelihood of survival after in-hospital cardiopulmonary resuscitation (CPR) for IHCA with good neurologic status. The final model was evaluated using the validation data set. The main outcomes measures were survival to discharge after in-hospital CPR for IHCA with good neurologic status (neurologically intact or with minimal deficits) based on a Cerebral Performance Category score of 1.
Results:
The best performing model was a simple point score based on 13 prearrest variables. The C statistic was 0.78 when applied to the validation set. It identified the likelihood of a good outcome as very low in 9.4% of patients (good outcome in 0.9%), low in 18.9% (good outcome in 1.7%), average in 54.0% (good outcome in 9.4%), and above average in 17.7% (good outcome in 27.5%). Overall, the score can identify more than one-quarter of patients as having a low or very low likelihood of survival to discharge, neurologically intact, or with minimal deficits after IHCA (good outcome in 1.4%).
Conclusions:
The authors concluded that their scoring system identifies patients who are unlikely to benefit from a resuscitation attempt should they experience IHCA.
Perspective:
The investigators have developed and validated a simple scoring system that can identify hospitalized patients having a very low, low, average, or higher than average likelihood of surviving to discharge neurologically intact or with minimal deficits following CPR for IHCA. This information could be potentially useful when counseling patients regarding their do not resuscitate (DNR) status. Because the clinical prediction rule uses information that is known at the time of hospital admission, it could also be built into the admissions process and used to identify patients who have little possibility of benefitting from CPR should they experience cardiac arrest. Overall, this scoring system may provide useful information for patients and physicians and, when integrated with information on patients’ values, beliefs, and goals, may be used as part of a shared decision making regarding do-not-attempt-resuscitation orders.
Keywords: Cardiopulmonary Resuscitation, Resuscitation Orders, Heart Arrest
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