Early findings on brain computed tomography and the prognosis of post-cardiac arrest syndrome: Application of the score for stroke patients☆

Abstract 

Aim

To examine whether early findings of the brain computed tomography (CT) evaluated by the modified Alberta stroke programme early CT (m-ASPECT) score is useful for determining the prognosis of post-cardiac arrest syndrome (PCAS) patients or not.

Materials

From 2003 through 2010, 149 consecutive PCAS patients: (1) with various aetiologies but neither from haemorrhagic stroke nor trauma, (2) who were 15years old or older and (3) whose brain CT was available were admitted to our intensive care unit. Early findings on all of their CT images were rated with the m-ASPECT scoring system by three raters, and an inter-rater comparison was conducted. Next, the images within 24h from arrest were collected from 133 patients (89 males, age 60.2±17.6years), and a relation of the scores with outcome at day 30 of the patients was analysed.

Results

According to the inter-rater comparison based on a linear regression analysis, agreement between the raters was good (correlation coefficient 0.76–0.88). A receiver operating curve analysis revealed that the m-ASPECT scores within 24h were a good predictor of poor outcome (dead or vegetative state) with an area under the curve of 0.905. An m-ASPECT score ≤13 was 100% predictive of a poor outcome, with a negative predictive value of 0.57. The m-ASPECT score was the best predictor of poor outcome (odds ratio 45.62) among various factors including cause or duration of arrest.

Conclusion

The m-APSECT score evaluated within 24h from arrest was found to be the most predictive factor for outcome at day 30.

Keywords: Intensive care unit, Persistent vegetative state, Hanging, Cerebral performance category