Observational studyJournal of the American Heart Association2025
External Validation of 3 Prediction Models for Mortality in Out-of-Hospital Cardiac Arrest Survivors: A Retrospective Multicenter Study.
Observational study in Journal of the American Heart Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
16 authors.
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Abstract
backgroundPredictive models such as the Cardiac Arrest Survival Score (CASS), FACTOR score, and Survival After ROSC in Cardiac Arrest (SARICA) have been developed to estimate in-hospital mortality in out-of-hospital cardiac arrest survivors. This study aims to externally validate and compare their predictive performance to determine their clinical utility upon emergency department admission.
methodsThis retrospective multicenter cohort study included out-of-hospital cardiac arrest patients admitted to the National Taiwan University Hospital and its branches between January 2016 and March 2024. The outcome was in-hospital mortality following intensive care unit admission. We assessed the CASS, FACTOR, and a modified SARICA (mSARICA) score using the area under the receiver operating characteristic curve, positive predictive value, and negative predictive value. The SARICA score was adapted into the mSARICA score to ensure outcome consistency. The positive predictive value threshold was set at 0.85 to minimize false-positive predictions.
resultsThe study included 1456 patients, of whom 495 (34%) survived to discharge and 961 (66%) died before discharge. The area under the receiver operating characteristics for CASS, FACTOR, and mSARICA were 0.684 (95% CI, 0.654-0.713), 0.677 (95% CI, 0.647-0.706), and 0.711 (95% CI, 0.682-0.739), respectively, with no significant differences among them. The optimal cutoff values were >17.5 for CASS, ≥69.25 for FACTOR, and <1.0 for mSARICA. While CASS and FACTOR demonstrated similar sensitivity, specificity, and negative predictive value, mSARICA exhibited significantly higher sensitivity, lower specificity, and higher negative predictive value.
conclusionsAll scores demonstrated fair but not excellent discrimination for in-hospital mortality. When minimizing false positives is critical, CASS and FACTOR may be preferable, whereas mSARICA offers greater sensitivity.
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