Accuracy of etiological classification of out-of-hospital cardiac arrest: A scoping review.
Resuscitation · 2024-04-04 · Scoping review
Abstract
INTRODUCTION: The Utstein reporting template classifies the etiology of OHCA into "presumed cardiac" and "obvious non-cardiac" or "medical" and "non-medical" categories; however, the accuracy of these classifications is unclear. Ascertaining more accurately the etiology of OHCA is important to tailor advanced life support and identify etiologically consistent patient cohorts for reporting incidence and outcome and enrollment in clinical trials. This scoping review was proposed to identify the state of agreement on etiological classification based on emergency medical service (EMS) data using the Utstein format against other sources. METHOD: We searched Medline, EBM-Cochrane, and Embase databases from 1946-2023 to identify studies that reported initial and confirmed etiologies of OHCA. A descriptive review of the included studies was conducted. RESULT: The search yielded 22,994 citations. After excluding duplicates, 16,932 citations were reviewed for titles and abstracts. Twelve studies met the inclusion criteria of this review. The frequency of presumed cardiac etiologies based on EMS data was higher than confirmed cardiac etiologies (88% vs 33%) with 83-94% sensitivity and 73-76% specificity. In contrast, the frequency of presumed non-cardiac etiologies was lower than confirmed non-cardiac etiologies (3% vs 27%) with 52-74% sensitivity and 90-97.7% specificity estimated for respiratory disease. CONCLUSION: Major disparities exist between current etiological classifications based on the Utstein reporting template and robust sources such as autopsy and medical records. Data linkage and validation are necessary to confirm the etiology of OHCA. Further research is needed on how this misclassification affects reported incidence and outcomes, and how contributing factors may improve etiological classifications.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Research methods & trial conduct
Related articles
- Reporting of Utstein-recommended variables in prehospital traumatic cardiac arrest: a scoping review. (BMC Emerg Med, 2026)
- Wolf Creek XVII part 3: Automated cardiac arrest diagnosis. (Resusc Plus, 2023)
- Cardiac arrest: an interdisciplinary scoping review of clinical literature from 2021 (Frontiers in Emergency Medicine, 2023)
- Clinical Predictive Models of Sudden Cardiac Arrest: A Survey of the Current Science and Analysis of Model Performances. (J Am Heart Assoc, 2020)
- Cardiac arrest and sudden cardiac death registries: a systematic review of global coverage. (Open Heart, 2020)
- Essential features of designating out-of-hospital cardiac arrest as a reportable event: a scientific statement from the American Heart Association Emergency Cardiovascular Care Committee; Council on Cardiopulmonary, Perioperative, and Critical Care; Council on Cardiovascular Nursing; Council on Clinical Cardiology; and Quality of Care and Outcomes Research Interdisciplinary Working Group. (Circulation, 2008)