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A pilot study of methods for prediction of poor outcome by head computed tomography after cardiac arrest

Lang, Margareta LU ; Nielsen, Niklas LU ; Ullén, Susann LU ; Abul-Kasim, Kasim LU ; Johnsson, Mikael ; Helbok, Raimund ; Leithner, Christoph ; Cronberg, Tobias LU and Moseby-Knappe, Marion LU (2022) In Resuscitation 179. p.61-70
Abstract

Introduction: In Sweden, head computed tomography (CT) is commonly used for prediction of neurological outcome after cardiac arrest, as recommended by guidelines. We compare the prognostic ability and interrater variability of routine and novel CT methods for prediction of poor outcome. Methods: Retrospective study including patients from Swedish sites within the Target Temperature Management after out-of-hospital cardiac arrest trial examined with CT. Original images were assessed by two independent radiologists blinded from clinical data with eye-balling without pre-specified criteria, and with a semi-quantitative assessment. Grey-white-matter ratios (GWR) were quantified using models with 4–20 manually placed regions of interest.... (More)

Introduction: In Sweden, head computed tomography (CT) is commonly used for prediction of neurological outcome after cardiac arrest, as recommended by guidelines. We compare the prognostic ability and interrater variability of routine and novel CT methods for prediction of poor outcome. Methods: Retrospective study including patients from Swedish sites within the Target Temperature Management after out-of-hospital cardiac arrest trial examined with CT. Original images were assessed by two independent radiologists blinded from clinical data with eye-balling without pre-specified criteria, and with a semi-quantitative assessment. Grey-white-matter ratios (GWR) were quantified using models with 4–20 manually placed regions of interest. Prognostic abilities and interrater variability were calculated for prediction of poor outcome (modified Rankin Scale 4–6 at 6 months) for early (<24 h) and late (≥24 h) examinations. Results: 68/106 (64 %) of included patients were examined < 24 h post-arrest. Eye-balling predicted poor outcome with 89–100 % specificity and 15–78 % sensitivity. GWR < 24 h predicted neurological outcome with unsatisfactory to satisfactory Area Under the Receiver Operating Characteristics Curve (AUROC: 0.54–0.64). GWR ≥ 24 h yielded very good to excellent AUROC (0.80–0.93). Sensitivities increased > 2–3-fold in examinations performed after 24 h compared to early examinations. Combining eye-balling with GWR < 1.15 predicted poor outcome without false positives with sensitivities remaining acceptable. Conclusion: In our cohort, qualitative and quantitative CT methods predicted poor outcome with high specificity and low to moderate sensitivity. Sensitivity increased relevantly after the first 24 h after CA. Interrater variability poses a problem and indicates the need to standardise brain CT evaluation to increase the methods’ safety.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Brain, Cardiac arrest, Computed tomography, GWR, Prognostication, Hypoxic-Ischaemic-Encephalopathy
in
Resuscitation
volume
179
pages
10 pages
publisher
Elsevier
external identifiers
  • pmid:35931271
  • scopus:85135804137
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2022.07.035
language
English
LU publication?
yes
id
7315d8a0-9cd3-4edf-a564-19216105671f
date added to LUP
2022-10-07 13:21:26
date last changed
2024-04-18 15:38:05
@article{7315d8a0-9cd3-4edf-a564-19216105671f,
  abstract     = {{<p>Introduction: In Sweden, head computed tomography (CT) is commonly used for prediction of neurological outcome after cardiac arrest, as recommended by guidelines. We compare the prognostic ability and interrater variability of routine and novel CT methods for prediction of poor outcome. Methods: Retrospective study including patients from Swedish sites within the Target Temperature Management after out-of-hospital cardiac arrest trial examined with CT. Original images were assessed by two independent radiologists blinded from clinical data with eye-balling without pre-specified criteria, and with a semi-quantitative assessment. Grey-white-matter ratios (GWR) were quantified using models with 4–20 manually placed regions of interest. Prognostic abilities and interrater variability were calculated for prediction of poor outcome (modified Rankin Scale 4–6 at 6 months) for early (&lt;24 h) and late (≥24 h) examinations. Results: 68/106 (64 %) of included patients were examined &lt; 24 h post-arrest. Eye-balling predicted poor outcome with 89–100 % specificity and 15–78 % sensitivity. GWR &lt; 24 h predicted neurological outcome with unsatisfactory to satisfactory Area Under the Receiver Operating Characteristics Curve (AUROC: 0.54–0.64). GWR ≥ 24 h yielded very good to excellent AUROC (0.80–0.93). Sensitivities increased &gt; 2–3-fold in examinations performed after 24 h compared to early examinations. Combining eye-balling with GWR &lt; 1.15 predicted poor outcome without false positives with sensitivities remaining acceptable. Conclusion: In our cohort, qualitative and quantitative CT methods predicted poor outcome with high specificity and low to moderate sensitivity. Sensitivity increased relevantly after the first 24 h after CA. Interrater variability poses a problem and indicates the need to standardise brain CT evaluation to increase the methods’ safety.</p>}},
  author       = {{Lang, Margareta and Nielsen, Niklas and Ullén, Susann and Abul-Kasim, Kasim and Johnsson, Mikael and Helbok, Raimund and Leithner, Christoph and Cronberg, Tobias and Moseby-Knappe, Marion}},
  issn         = {{0300-9572}},
  keywords     = {{Brain; Cardiac arrest; Computed tomography; GWR; Prognostication, Hypoxic-Ischaemic-Encephalopathy}},
  language     = {{eng}},
  pages        = {{61--70}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{A pilot study of methods for prediction of poor outcome by head computed tomography after cardiac arrest}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2022.07.035}},
  doi          = {{10.1016/j.resuscitation.2022.07.035}},
  volume       = {{179}},
  year         = {{2022}},
}