Observational studyThe western journal of emergency medicine2025
Factors Associated with Survival to Hospital Discharge in Cardiac Arrest by Poisoning: WAIVOR Score.
Observational study in The western journal of emergency medicine, 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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Abstract
introductionPoisoning-induced out-of-hospital cardiac arrest (P-OHCA) is a leading mortality cause; however, no specific prognostic model exists for P-OHCA. In this study we aimed to develop and validate a novel scoring system, the WAIVOR score, which identifies factors associated with survival to hospital discharge in patients with P-OHCA, including the nature of the toxic agent.
methodsIn this retrospective nationwide observational study we analyzed 4,252 South Korean adult P-OHCA cases from 2013-2023. The study population was randomly stratified into derivation (n = 2,834) and validation (n = 1,418) cohorts. Independent factors associated with survival to hospital discharge were identified through multivariable logistic regression analysis, yielding adjusted odds ratios (aOR) and 95% confidence intervals (CI). We assessed the scoring system's discriminative performance using the receiver operating characteristic curve and area under the curve (AUC) analysis, with optimal threshold determination via the Youden index.
resultsAmong all patients, 291 (6.8%) survived to hospital discharge. The most frequent poisoning substances were gases/vapors (45.3%), pesticides (31.5%), and medically prescribed drugs (12.0%). Six independent factors associated with survival to hospital discharge were incorporated into the WAIVOR score (maximum 11 points): pre-hospital return of spontaneous circulation, four points (aOR 16.11, 95% CI 10.16-25.64); witnessed arrest, two points (aOR 3.86, 95% CI 2.61-5.71); age < 65 years, two points (aOR 3.34, 95% CI 2.20-5.15); female sex, one point (aOR 1.54, 95% CI 1.09-2.16); and arrest-to-emergency department intervals ≤ 30 minutes, two points (aOR 3.44, 95% CI 2.00-6.09; 31-60 minutes, one point (aOR 1.77, 95% CI 1.08-3.02); and poisoning by non-gas/non-vapor substances, one point (aOR 0.54, 95% CI 0.33-0.89). The WAIVOR score demonstrated robust discriminative performance (AUC: 0.823 and 0.739 in derivation and validation cohorts, respectively). At the optimal threshold of five points, the score demonstrated 53.6% sensitivity, 84.4% specificity, 19.8% positive predictive value, and 96.2% negative predictive value (NPV).
conclusionThe WAIVOR score represents a practical tool whose associated factors may help assess potential for survival to hospital discharge in patients with P-OHCA. Its high NPV renders it valuable for identifying poor prognostic outcomes. However, further external validation studies are required before this score can be broadly used in decisions regarding resuscitation termination in clinical practice.
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