Timing of brain computed tomography and accuracy of outcome prediction after cardiac arrest

Kaspar Josche Streitberger, Christian Endisch, Christoph J. Ploner, Robert Stevens, Michael Scheel, Martin Kenda, Christian Storm, Christoph Leithner

Research output: Contribution to journalArticle

Abstract

Aim: Gray–white-matter ratio (GWR) calculated from head CT is a radiologic index of tissue changes associated with hypoxic-ischemic encephalopathy after cardiac arrest (CA). Evidence from previous studies indicates high specificity for poor outcome prediction at GWR thresholds of 1.10–1.20. We aimed to determine the relationship between accuracy of neurologic prognostication by GWR and timing of CT. Methods: We included 195 patients admitted to the ICU following CA. GWR was calculated from CT radiologic densities in 16 regions of interest. Outcome was determined upon intensive care unit discharge using the cerebral performance category (CPC). Accuracy of outcome prediction of GWR was compared for 3 epochs (<6, 6–24, and >24 h after CA). Results: 125 (64%) patients had poor (CPC4–5) and 70 (36%) good outcome (CPC1–3). Irrespective of timing, specificity for poor outcome prediction was 100% at a GWR threshold of 1.10. Among 50 patients with both early and late CT, GWR decreased significantly over time (p = 0.002) in patients with poor outcome, sensitivity for poor outcome prediction was 12% (7–20%) with early CTs (<6 h) and 48% (38–58%) for late CTs (>24 h). Across all patients, sensitivity of early and late CT was 17% (9–28%) and 39% (28–51%), respectively. Conclusion: A GWR below 1.10 predicts poor outcome (CPC4–5) in patients after CA with high specificity irrespective of time of acquisition of CT. Because GWR decreases over time in patients with severe HIE, sensitivity for prediction of poor outcome is higher for late CTs (>24 h after CA) as compared to early CTs (<6 h after CA).

Original languageEnglish (US)
Pages (from-to)8-14
Number of pages7
JournalResuscitation
Volume145
DOIs
StatePublished - Dec 2019
Externally publishedYes

Fingerprint

Heart Arrest
Tomography
Brain
Brain Hypoxia-Ischemia
Nervous System
Intensive Care Units
Head

Keywords

  • Cardiac arrest
  • Computed tomography (CT)
  • Grey-white-matter-ration (GWR)
  • Outcome prediction
  • Prognostication
  • Therapeutic hypothermia

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

Streitberger, K. J., Endisch, C., Ploner, C. J., Stevens, R., Scheel, M., Kenda, M., ... Leithner, C. (2019). Timing of brain computed tomography and accuracy of outcome prediction after cardiac arrest. Resuscitation, 145, 8-14. https://doi.org/10.1016/j.resuscitation.2019.09.025

Timing of brain computed tomography and accuracy of outcome prediction after cardiac arrest. / Streitberger, Kaspar Josche; Endisch, Christian; Ploner, Christoph J.; Stevens, Robert; Scheel, Michael; Kenda, Martin; Storm, Christian; Leithner, Christoph.

In: Resuscitation, Vol. 145, 12.2019, p. 8-14.

Research output: Contribution to journalArticle

Streitberger, KJ, Endisch, C, Ploner, CJ, Stevens, R, Scheel, M, Kenda, M, Storm, C & Leithner, C 2019, 'Timing of brain computed tomography and accuracy of outcome prediction after cardiac arrest', Resuscitation, vol. 145, pp. 8-14. https://doi.org/10.1016/j.resuscitation.2019.09.025
Streitberger, Kaspar Josche ; Endisch, Christian ; Ploner, Christoph J. ; Stevens, Robert ; Scheel, Michael ; Kenda, Martin ; Storm, Christian ; Leithner, Christoph. / Timing of brain computed tomography and accuracy of outcome prediction after cardiac arrest. In: Resuscitation. 2019 ; Vol. 145. pp. 8-14.
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abstract = "Aim: Gray–white-matter ratio (GWR) calculated from head CT is a radiologic index of tissue changes associated with hypoxic-ischemic encephalopathy after cardiac arrest (CA). Evidence from previous studies indicates high specificity for poor outcome prediction at GWR thresholds of 1.10–1.20. We aimed to determine the relationship between accuracy of neurologic prognostication by GWR and timing of CT. Methods: We included 195 patients admitted to the ICU following CA. GWR was calculated from CT radiologic densities in 16 regions of interest. Outcome was determined upon intensive care unit discharge using the cerebral performance category (CPC). Accuracy of outcome prediction of GWR was compared for 3 epochs (<6, 6–24, and >24 h after CA). Results: 125 (64{\%}) patients had poor (CPC4–5) and 70 (36{\%}) good outcome (CPC1–3). Irrespective of timing, specificity for poor outcome prediction was 100{\%} at a GWR threshold of 1.10. Among 50 patients with both early and late CT, GWR decreased significantly over time (p = 0.002) in patients with poor outcome, sensitivity for poor outcome prediction was 12{\%} (7–20{\%}) with early CTs (<6 h) and 48{\%} (38–58{\%}) for late CTs (>24 h). Across all patients, sensitivity of early and late CT was 17{\%} (9–28{\%}) and 39{\%} (28–51{\%}), respectively. Conclusion: A GWR below 1.10 predicts poor outcome (CPC4–5) in patients after CA with high specificity irrespective of time of acquisition of CT. Because GWR decreases over time in patients with severe HIE, sensitivity for prediction of poor outcome is higher for late CTs (>24 h after CA) as compared to early CTs (<6 h after CA).",
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T1 - Timing of brain computed tomography and accuracy of outcome prediction after cardiac arrest

AU - Streitberger, Kaspar Josche

AU - Endisch, Christian

AU - Ploner, Christoph J.

AU - Stevens, Robert

AU - Scheel, Michael

AU - Kenda, Martin

AU - Storm, Christian

AU - Leithner, Christoph

PY - 2019/12

Y1 - 2019/12

N2 - Aim: Gray–white-matter ratio (GWR) calculated from head CT is a radiologic index of tissue changes associated with hypoxic-ischemic encephalopathy after cardiac arrest (CA). Evidence from previous studies indicates high specificity for poor outcome prediction at GWR thresholds of 1.10–1.20. We aimed to determine the relationship between accuracy of neurologic prognostication by GWR and timing of CT. Methods: We included 195 patients admitted to the ICU following CA. GWR was calculated from CT radiologic densities in 16 regions of interest. Outcome was determined upon intensive care unit discharge using the cerebral performance category (CPC). Accuracy of outcome prediction of GWR was compared for 3 epochs (<6, 6–24, and >24 h after CA). Results: 125 (64%) patients had poor (CPC4–5) and 70 (36%) good outcome (CPC1–3). Irrespective of timing, specificity for poor outcome prediction was 100% at a GWR threshold of 1.10. Among 50 patients with both early and late CT, GWR decreased significantly over time (p = 0.002) in patients with poor outcome, sensitivity for poor outcome prediction was 12% (7–20%) with early CTs (<6 h) and 48% (38–58%) for late CTs (>24 h). Across all patients, sensitivity of early and late CT was 17% (9–28%) and 39% (28–51%), respectively. Conclusion: A GWR below 1.10 predicts poor outcome (CPC4–5) in patients after CA with high specificity irrespective of time of acquisition of CT. Because GWR decreases over time in patients with severe HIE, sensitivity for prediction of poor outcome is higher for late CTs (>24 h after CA) as compared to early CTs (<6 h after CA).

AB - Aim: Gray–white-matter ratio (GWR) calculated from head CT is a radiologic index of tissue changes associated with hypoxic-ischemic encephalopathy after cardiac arrest (CA). Evidence from previous studies indicates high specificity for poor outcome prediction at GWR thresholds of 1.10–1.20. We aimed to determine the relationship between accuracy of neurologic prognostication by GWR and timing of CT. Methods: We included 195 patients admitted to the ICU following CA. GWR was calculated from CT radiologic densities in 16 regions of interest. Outcome was determined upon intensive care unit discharge using the cerebral performance category (CPC). Accuracy of outcome prediction of GWR was compared for 3 epochs (<6, 6–24, and >24 h after CA). Results: 125 (64%) patients had poor (CPC4–5) and 70 (36%) good outcome (CPC1–3). Irrespective of timing, specificity for poor outcome prediction was 100% at a GWR threshold of 1.10. Among 50 patients with both early and late CT, GWR decreased significantly over time (p = 0.002) in patients with poor outcome, sensitivity for poor outcome prediction was 12% (7–20%) with early CTs (<6 h) and 48% (38–58%) for late CTs (>24 h). Across all patients, sensitivity of early and late CT was 17% (9–28%) and 39% (28–51%), respectively. Conclusion: A GWR below 1.10 predicts poor outcome (CPC4–5) in patients after CA with high specificity irrespective of time of acquisition of CT. Because GWR decreases over time in patients with severe HIE, sensitivity for prediction of poor outcome is higher for late CTs (>24 h after CA) as compared to early CTs (<6 h after CA).

KW - Cardiac arrest

KW - Computed tomography (CT)

KW - Grey-white-matter-ration (GWR)

KW - Outcome prediction

KW - Prognostication

KW - Therapeutic hypothermia

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