Abstract
Background
Cerebral Performance Category (CPC), Modified Rankin Scale (mRS) and discharge disposition
are commonly used to determine outcomes following cardiac arrest. This study tested
the association between these outcome measures.
Methods
Retrospective chart review of subjects who survived to hospital discharge between
1/1/2006 and 12/31/2009 was conducted. Charts were reviewed for outcomes (CPC, mRS,
and discharge disposition). Discharge disposition was classified in 6 categories:
home with no services, home with home healthcare, acute rehabilitation facility, skilled
nursing facility, long term acute care facility, and hospice. Intra-and inter-rater
reliabilities were calculated for outcome measures. Rates of “good outcome” (defined
as a CPC of 1–2, mRS of 0–3, or discharge disposition to home or acute rehabilitation
facility) were also determined. Kendall's tau correlation coefficients explored relationships
among measures.
Results
A total of 211 charts were reviewed. Mean age was 60 years (SD 16), the majority (75%)
were white males, in- and out-of hospital cardiac arrests were equally prevalent,
and ventricular dysrhythmia was most common (N = 109, 52%). Half of the subjects were comatose following resuscitation and 75 (35%)
received therapeutic hypothermia. Inter-rater percentage agreement for CPC and mRS
abstraction was 95.24% (kappa 0.89, p < 0.001) and 95.24% (kappa 0.90, p < 0.001) respectively. “Good outcomes” were found in 44 subjects (20%) using the CPC
definition, 47 subjects (22%) using the mRS definition, and 129 subjects (61%) subjects
using discharge disposition definition. There was fair relationship between the CPC
and mRS (tau 0.43) and poor relationships between CPC and discharge disposition (tau
0.23) and between mRS and discharge disposition (tau 0.25).
Conclusions
Determination of the CPC, mRS and discharge disposition at hospital discharge is reliable
from chart review. These instruments provide widely differing estimates of “good outcome”.
Agreement between these measures ranges from poor to fair. A more nuanced outcome
measure designed for the post-cardiac arrest population is needed.
Abbreviations:
mRS (Modified Rankin Scale), CPC (Cerebral Performance Category), Home (discharge to home with no services), Home-care (discharge to home with home health care), Acute rehabilitation (discharge to acute rehabilitation facility), SNF (skilled nursing facility), LTAC (long-term acute care hospital), Hospice (discharge to home hospice or hospice facility)Keywords
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Article info
Publication history
Published online: April 27, 2011
Accepted:
March 31,
2011
Received in revised form:
March 29,
2011
Received:
October 19,
2010
Footnotes
☆A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.03.034.
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
