External validation of the simple NULL-PLEASE clinical score in predicting outcomes of out-of-hospital cardiac arrest in the Danish population – A nationwide registry-based study. (November 2022)

• Record Type: Journal Article
• Authors: Byrne, Christina; Barcella, Carlo A.; Krogager, Maria Lukacs; Pareek, Manan; Ringgren, Kristian Bundgaard; Andersen, Mikkel Porsborg; Mills, Elisabeth Helen Anna; Wissenberg, Mads; Folke, Fredrik; Gislason, Gunnar; Køber, Lars; Lippert, Freddy; Kjærgaard, Jesper; Hassager, Christian; Torp-Pedersen, Christian; Kragholm, Kristian; Lip, Gregory Y.H.
• Is Part Of: Resuscitation. Volume 180(2022)
• Page Start: 128
• Page End: 136
• Publication Date: 2022-11
• Subjects: Mortality -- NULL-PLEASE score -- Outcome -- Out-of-hospital cardiac arrest -- Prediction -- Resuscitation; ROSC Return of spontaneous circulation -- OHCA Out-of-hospital cardiac arrest -- AUCROC Area under the receiver operating characteristics -- EMS Emergency medical services -- ICD International Classification of Diseases; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2022.08.009
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Aim: The NULL-PLEASE score (Nonshockable rhythm, Unwitnessed arrest, Long no-flow or Long low-flow period, blood pH < 7.2, Lactate > 7.0 mmol/L, End-stage renal disease on dialysis, Age ≥85 years, Still resuscitation, and Extracardiac cause) may identify patients with out-of-hospital cardiac arrest (OHCA) unlikely to survive. We aimed to validate the NULL-PLEASE score in a nationwide setting. Methods: We used Danish nationwide registry data from 2001 to 2019 and identified OHCA survivors with return of spontaneous circulation (ROSC) or ongoing cardiopulmonary resuscitation at hospital arrival. The primary outcome was 1-day mortality. Secondary outcomes were 30-day mortality and the combined outcome of 1-year mortality or anoxic brain damage. The risks of outcomes were estimated using logistic regression with a NULL-PLEASE score of 0 as reference (range 0–14). The predictive ability of the score was examined using the area under the receiver operating characteristics (AUCROC ) curve. Results: A total of 3, 881 patients were included in the analyses. One-day mortality was 35%, 30-day mortality was 61%, and 68% experienced the combined outcome. For a NULL-PLEASE score ≥9 ( n = 244) the absolute risks were: 1-day mortality: 80.7% (95% confidence interval [CI]: 75.8–85.7%); 30-day mortality: 98.0% (95% CI: 96.2–99.7%); and the combined outcome: 98.4% (95% CI: 96.8–100.0%). Corresponding AUCROC values were 0.800 (95% CI: 0.786–0.814) for 1-day mortality, 0.827 (95% CI: 0.814–0.840) for 30-day mortality, and 0.828 (95% CI: 0.815–0.841) for the combined outcome. Conclusions: In a nationwide OHCA-cohort, AUCROC values for the predictive ability of NULL-PLEASE were high for all outcomes. However, some survived even with high NULL-PLEASE scores.