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Standardised and automated assessment of head computed tomography reliably predicts poor functional outcome after cardiac arrest : a prospective multicentre study

Lang, Margareta LU ; Kenda, Martin ; Scheel, Michael ; Martola, Juha ; Wheeler, Matthew ; Owen, Stephanie ; Johnsson, Mikael ; Annborn, Martin LU ; Dankiewicz, Josef LU orcid and Deye, Nicolas , et al. (2024) In Intensive Care Medicine 50(7). p.1096-1107
Abstract

Purpose: Application of standardised and automated assessments of head computed tomography (CT) for neuroprognostication after out-of-hospital cardiac arrest. Methods: Prospective, international, multicentre, observational study within the Targeted Hypothermia versus Targeted Normothermia after out-of-hospital cardiac arrest (TTM2) trial. Routine CTs from adult unconscious patients obtained > 48 h ≤ 7 days post-arrest were assessed qualitatively and quantitatively by seven international raters blinded to clinical information using a pre-published protocol. Grey–white-matter ratio (GWR) was calculated from four (GWR-4) and eight (GWR-8) regions of interest manually placed at the basal ganglia level. Additionally, GWR was obtained... (More)

Purpose: Application of standardised and automated assessments of head computed tomography (CT) for neuroprognostication after out-of-hospital cardiac arrest. Methods: Prospective, international, multicentre, observational study within the Targeted Hypothermia versus Targeted Normothermia after out-of-hospital cardiac arrest (TTM2) trial. Routine CTs from adult unconscious patients obtained > 48 h ≤ 7 days post-arrest were assessed qualitatively and quantitatively by seven international raters blinded to clinical information using a pre-published protocol. Grey–white-matter ratio (GWR) was calculated from four (GWR-4) and eight (GWR-8) regions of interest manually placed at the basal ganglia level. Additionally, GWR was obtained using an automated atlas-based approach. Prognostic accuracies for prediction of poor functional outcome (modified Rankin Scale 4–6) for the qualitative assessment and for the pre-defined GWR cutoff < 1.10 were calculated. Results: 140 unconscious patients were included; median age was 68 years (interquartile range [IQR] 59–76), 76% were male, and 75% had poor outcome. Standardised qualitative assessment and all GWR models predicted poor outcome with 100% specificity (95% confidence interval [CI] 90–100). Sensitivity in median was 37% for the standardised qualitative assessment, 39% for GWR-8, 30% for GWR-4 and 41% for automated GWR. GWR-8 was superior to GWR-4 regarding prognostic accuracies, intra- and interrater agreement. Overall prognostic accuracy for automated GWR (area under the curve [AUC] 0.84, 95% CI 0.77–0.91) did not significantly differ from manually obtained GWR. Conclusion: Standardised qualitative and quantitative assessments of CT are reliable and feasible methods to predict poor functional outcome after cardiac arrest. Automated GWR has the potential to make CT quantification for neuroprognostication accessible to all centres treating cardiac arrest patients.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiac arrest, Computed tomography, GWR, Hypoxic–ischaemic encephalopathy, Prognosis
in
Intensive Care Medicine
volume
50
issue
7
pages
12 pages
publisher
Springer
external identifiers
  • pmid:38900283
  • scopus:85196384410
ISSN
0342-4642
DOI
10.1007/s00134-024-07497-2
language
English
LU publication?
yes
id
f1c87b2d-5c47-4938-b990-71b27dc9ad77
date added to LUP
2024-09-11 16:18:35
date last changed
2024-09-11 16:19:02
@article{f1c87b2d-5c47-4938-b990-71b27dc9ad77,
  abstract     = {{<p>Purpose: Application of standardised and automated assessments of head computed tomography (CT) for neuroprognostication after out-of-hospital cardiac arrest. Methods: Prospective, international, multicentre, observational study within the Targeted Hypothermia versus Targeted Normothermia after out-of-hospital cardiac arrest (TTM2) trial. Routine CTs from adult unconscious patients obtained &gt; 48 h ≤ 7 days post-arrest were assessed qualitatively and quantitatively by seven international raters blinded to clinical information using a pre-published protocol. Grey–white-matter ratio (GWR) was calculated from four (GWR-4) and eight (GWR-8) regions of interest manually placed at the basal ganglia level. Additionally, GWR was obtained using an automated atlas-based approach. Prognostic accuracies for prediction of poor functional outcome (modified Rankin Scale 4–6) for the qualitative assessment and for the pre-defined GWR cutoff &lt; 1.10 were calculated. Results: 140 unconscious patients were included; median age was 68 years (interquartile range [IQR] 59–76), 76% were male, and 75% had poor outcome. Standardised qualitative assessment and all GWR models predicted poor outcome with 100% specificity (95% confidence interval [CI] 90–100). Sensitivity in median was 37% for the standardised qualitative assessment, 39% for GWR-8, 30% for GWR-4 and 41% for automated GWR. GWR-8 was superior to GWR-4 regarding prognostic accuracies, intra- and interrater agreement. Overall prognostic accuracy for automated GWR (area under the curve [AUC] 0.84, 95% CI 0.77–0.91) did not significantly differ from manually obtained GWR. Conclusion: Standardised qualitative and quantitative assessments of CT are reliable and feasible methods to predict poor functional outcome after cardiac arrest. Automated GWR has the potential to make CT quantification for neuroprognostication accessible to all centres treating cardiac arrest patients.</p>}},
  author       = {{Lang, Margareta and Kenda, Martin and Scheel, Michael and Martola, Juha and Wheeler, Matthew and Owen, Stephanie and Johnsson, Mikael and Annborn, Martin and Dankiewicz, Josef and Deye, Nicolas and Düring, Joachim and Friberg, Hans and Halliday, Thomas and Jakobsen, Janus Christian and Lascarrou, Jean Baptiste and Levin, Helena and Lilja, Gisela and Lybeck, Anna and McGuigan, Peter and Rylander, Christian and Sem, Victoria and Thomas, Matthew and Ullén, Susann and Undén, Johan and Wise, Matt P. and Cronberg, Tobias and Wassélius, Johan and Nielsen, Niklas and Leithner, Christoph and Moseby-Knappe, Marion}},
  issn         = {{0342-4642}},
  keywords     = {{Cardiac arrest; Computed tomography; GWR; Hypoxic–ischaemic encephalopathy; Prognosis}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{1096--1107}},
  publisher    = {{Springer}},
  series       = {{Intensive Care Medicine}},
  title        = {{Standardised and automated assessment of head computed tomography reliably predicts poor functional outcome after cardiac arrest : a prospective multicentre study}},
  url          = {{http://dx.doi.org/10.1007/s00134-024-07497-2}},
  doi          = {{10.1007/s00134-024-07497-2}},
  volume       = {{50}},
  year         = {{2024}},
}