ArticleBMC emergency medicine2026
External validation of the CRASS score for predicting good neurological outcome in out-of-hospital cardiac arrest: analysis from cardiac-origin and non-cardiac origin cohorts.
Article in BMC emergency medicine, 2026. 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
backgroundThis study aimed to externally validate the CaRdiac Arrest Survival Score (CRASS) for predicting good neurological outcomes in Asian patients with out-of-hospital cardiac arrest (OHCA), focusing on cardiac-origin and noncardiac-origin cohorts, respectively.
methodsThis multicenter retrospective cohort study, conducted from January 2016 to December 2023 across three hospitals in Taiwan, included patients with OHCA with resuscitation attempts, and excluded those with trauma-related arrests, pediatric cases, or missing data. The CRASS score was calculated for each patient according to the clinical variables at presentation. The outcome involves a good neurological outcome (Cerebral Performance Category (CPC) 1 or 2) at hospital discharge. Predictive performance was evaluated using the area under the receiver operating characteristic curve (AUROC), calibration plots, and other performance metrics, including sensitivity, specificity, and positive and negative predictive values.
resultsThis study analyzed 1,311 patients with OHCA (667 cardiac-origin and 644 noncardiac-origin). The AUROC for predicting good neurological outcomes was 0.770 (95% confidence interval [CI]: 0.733–0.807) in the cardiac-origin cohort compared with 0.729 (95% CI: 0.661–0.796) in the noncardiac-origin cohort. The CRASS score exhibited better predictive performance in patients with cardiac origin, with an optimal cut-off value of 1.45, thereby supporting more aggressive treatment. The score in patients with noncardiac origin was more effective in predicting poor neurological outcomes, with an optimal cut-off value of − 1.47, favoring life support withdrawal.
conclusionsThe CRASS score is effective for predicting good neurological outcomes in patients with cardiac-origin OHCA but is more suited to guiding treatment withdrawal in noncardiac-origin cases. CLINICAL TRIAL NUMBER: Not applicable.
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