Accuracy of the first interpretation of early brain CT images for predicting the prognosis of post-cardiac arrest syndrome patients at the emergency department

Mitsuaki Nishikimi; Takayuki Ogura; Kota Matsui; Kunihiko Takahashi; Kenji Fukaya; Keibun Liu; Hideo Morita; Mitsunobu Nakamura; Shigeyuki Matsui; Naoyuki Matsuda

doi:10.1186/s40560-018-0296-6

Accuracy of the first interpretation of early brain CT images for predicting the prognosis of post-cardiac arrest syndrome patients at the emergency department

J Intensive Care. 2018 Apr 25:6:26. doi: 10.1186/s40560-018-0296-6. eCollection 2018.

Affiliations

¹ 1Department of Emergency and Critical Care, Nagoya University Graduate School of Medicine, Tsurumai-cho 64, Syowa-ku, Nagoya, Aichi 466-8560 Japan.
² Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan.
³ 3Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
⁴ Department of Diagnostic Radiology, Japan Red Cross Maebashi Hospital, Maebashi, Japan.

Abstract

Background: Early brain CT is one of the most useful tools for estimating the prognosis in patients with post-cardiac arrest syndrome (PCAS) at the emergency department (ED). The aim of this study was to evaluate the prognosis-prediction accuracy of the emergency physicians' interpretation of the findings on early brain CT in PCAS patients treated by targeted temperature management (TTM).

Methods: This was a double-center, retrospective, observational study. Eligible subjects were cardiac arrest patients admitted to the intensive care unit (ICU) for TTM between April 2011 and March 2017. We performed the McNemar test to compare the predictive accuracies of the interpretation by emergency physicians and radiologists and calculated the kappa statistic for determining the concordance rate between the interpretations by these two groups.

Results: Of the 122 eligible patients, 106 met the inclusion criteria for this study. The predictive accuracies (sensitivity, specificity) of the interpretations by the emergency physicians and radiologists were (0.34, 1.00) and (0.41, 0.93), respectively, with no significant difference in either the sensitivity or specificity as assessed by the McNemar test. The kappa statistic calculated to determine the concordance between the two interpretations was 0.66 (0.48-0.83), which showed a good conformity.

Conclusions: The emergency physicians' interpretation of the early brain CT findings in PCAS patients treated by TTM was as reliable as that of radiologists, in terms of prediction of the prognosis.

Keywords: Brain CT scan; Cardiac arrest; Neurological prognosis; Post-cardiac arrest syndrome; Targeted temperature management.