TY - JOUR
T1 - Standardised and automated assessment of head computed tomography reliably predicts poor functional outcome after cardiac arrest
T2 - a prospective multicentre study
AU - Lang, Margareta
AU - Kenda, Martin
AU - Scheel, Michael
AU - Martola, Juha
AU - Wheeler, Matthew
AU - Owen, Stephanie
AU - Johnsson, Mikael
AU - Annborn, Martin
AU - Dankiewicz, Josef
AU - Deye, Nicolas
AU - Düring, Joachim
AU - Friberg, Hans
AU - Halliday, Thomas
AU - Jakobsen, Janus Christian
AU - Lascarrou, Jean-Baptiste
AU - Levin, Helena
AU - Lilja, Gisela
AU - Lybeck, Anna
AU - McGuigan, Peter
AU - Rylander, Christian
AU - Sem, Victoria
AU - Thomas, Matthew
AU - Ullén, Susann
AU - Undén, Johan
AU - Wise, Matt P
AU - Cronberg, Tobias
AU - Wassélius, Johan
AU - Nielsen, Niklas
AU - Leithner, Christoph
AU - Moseby-Knappe, Marion
N1 - © 2024. The Author(s).
PY - 2024/7
Y1 - 2024/7
N2 - 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.
AB - 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.
KW - Aged
KW - Female
KW - Head/diagnostic imaging
KW - Humans
KW - Hypothermia, Induced/methods
KW - Male
KW - Middle Aged
KW - Out-of-Hospital Cardiac Arrest/therapy
KW - Predictive Value of Tests
KW - Prognosis
KW - Prospective Studies
KW - Tomography, X-Ray Computed/methods
KW - GWR
KW - Hypoxic–ischaemic encephalopathy
KW - Cardiac arrest
KW - Computed tomography
UR - http://www.scopus.com/inward/record.url?scp=85196384410&partnerID=8YFLogxK
U2 - 10.1007/s00134-024-07497-2
DO - 10.1007/s00134-024-07497-2
M3 - Journal article
C2 - 38900283
SN - 0342-4642
VL - 50
SP - 1096
EP - 1107
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 7
ER -