IMR Press / RCM / Volume 24 / Issue 1 / DOI: 10.31083/j.rcm2401025
Open Access Original Research
Combination of Cerebral Computed Tomography and Simplified Cardiac Arrest Hospital Prognosis (sCAHP) Score for Predicting Neurological Recovery in Cardiac Arrest Survivors
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1 Department of Emergency Medicine, National Taiwan University Medical College and Hospital, 100 Taipei, Taiwan
2 Department of Internal Medicine (Cardiology division), National Taiwan University Medical College and Hospital, 100 Taipei, Taiwan
3 Department of Internal Medicine, Min-Sheng General Hospital, 330 Taoyuan, Taiwan
*Correspondence: (Min-Shan Tsai)
Academic Editor: Zhonghua Sun
Rev. Cardiovasc. Med. 2023, 24(1), 25;
Submitted: 8 October 2022 | Revised: 20 November 2022 | Accepted: 30 November 2022 | Published: 12 January 2023
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: Cerebral computed tomography (CT) and various severity scoring systems have been developed for the early prediction of the neurological outcomes of cardiac arrest survivors. However, few studies have combined these approaches. Therefore, we evaluated the value of the combination of cerebral CT and severity score for neuroprognostication. Methods: This single-center, retrospective observational study included consecutive patients surviving nontraumatic cardiac arrest (January 2016 and December 2020). Gray-to-white ratio (GWR), third and fourth ventricle characteristics, and medial temporal lobe atrophy scores were evaluated on noncontrast cerebral CT. Simplified cardiac arrest hospital prognosis (sCAHP) score was calculated for severity assessment. The associations between the CT characteristics, sCAHP score and neurological outcomes were analyzed. Results: This study enrolled 559 patients. Of them, 194 (34.7%) were discharged with favorable neurological outcomes. Patients with favorable neurological outcome had a higher GWR (1.37 vs 1.25, p < 0.001), area of fourth ventricle (461 vs 413 mm2, p < 0.001), anteroposterior diameter of fourth ventricle (0.95 vs 0.86 cm , p < 0.001) and a lower sCAHP score (146 vs 190, p < 0.001) than those with poor recovery. Patients with higher sCAHP score had lower GWR (p trend < 0.001), area of fourth ventricle (p trend = 0.019) and anteroposterior diameter of fourth ventricle (p trend = 0.014). The predictive ability by using area under receiver operating characteristic curve (AUC) for the combination of sCAHP score and GWR was significantly higher than that calculated for sCAHP (0.86 vs 0.76, p < 0.001) or GWR (0.86 vs 0.81, p = 0.001) alone. Conclusions: The combination of GWR and sCAHP score can be used to effectively predict the neurological outcomes of cardiac arrest survivors and thus ensure timely intervention for those at high risk of poor recovery.

severity score
cardiac arrest
gray-to-white ratio
cerebral CT
Fig. 1.
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