Brainstem Reflex Score: A Novel Method for Early Prognostication in Patients After Outofhospital Cardiac Arrest

1Johns Hopkins Medical Institutions, Baltimore, MD
2Brigham and Woman's Hospital, Boston, MA
3Guthrie Clinic, Sayre, PA

Meeting: Hospital Medicine 2012, April 1-4, San Diego, Calif.

Abstract number: 97639

Background:

Practice Parameters for prognostication after out–of–hospital cardiac arrest, set forth by the American Academy of Neurology, stress the importance of the neurologic exam findings at 72 hours after successful resuscitation. Absent pupillary or corneal reflexes and absent or extensor motor response at 72 hours after arrest, are individual indicators of poor outcome. We sought in this study to test the ability of a simple clinical tool used within 24 hours of hospital admission, the Brainstem Reflex Score (BRS), to predict discharge outcome in patients with out–of–hospital cardiac arrest.

Methods:

We evaluated 141 survivors of non–traumatic out–of–hospital cardiac arrest admitted to an academic medical center. Data were collected according to Utstein guidelines. Daily neurologic examination was performed and a brainstem reflex score (BRS) was derived from five brainstem reflexes: 1) pupillary reflex, 2) corneal reflex, 3) cough/gag reflex, 4) oculocephalic reflex (doll’s eye), and 5) spontaneous breathing. We assumed that each brainstem reflex has an equal impact and assigned one point for each reflex present, giving a range of the BRS from 0 (worst) to 5 (best). Glasgow–Pittsburgh Cerebral Performance Category (CPC) Score was used to evaluate neurologic functional status upon discharge with CPC 1–2 noted as good and CPC 3–5 as bad neurologic outcome. BRS<3 (absence of 3 or more reflexes) within 24 hours of admission was evaluated for prediction of outcome and neurologic functional status upon discharge using descriptive statistics on the basis of 2 x 2 tables analysis.

Results:

Of 141 patients with median age of 66 years (inter–quartile range= 24), 55 (39%) were females, 100 (71%) had a witnessed arrest, 52 (37%) received bystander CPR, 32 (23%) had VF/VT as their initial arrest rhythm and median time from collapse to return of spontaneous circulation (ROSC) was 35 minutes. Also, 96 (68%) were sedated during the initial 24 hours, 65 (46%) received hypothermia and 34 (24.1%) survived to discharge with only 26 (18.4%) patients discharged with good neurologic function (CPC 1–2). The sensitivity and specificity of a BRS<3 (absence of 3 or more reflexes) for predicting poor discharge outcome were 92% and 44% respectively (PPV=84% and NPV=63%) and 88% and 39% respectively (PPV=86% and NPV=42%) for predicting poor neurologic function (CPC 3–5) on discharge.

Conclusions:

The Brainstem Reflex Score is a novel and simple clinical tool that can be used within 24 hours of hospital admission by Intensive Care Unit practitioners, regardless of specialty, to predict with relatively high accuracy and precision the discharge outcome in patients with out–of–hospital cardiac arrest.

To cite this abstract:

Abougergi M, Chandra–Strobos N, Llinas R, Eid S, Lakshmanadoss U. Brainstem Reflex Score: A Novel Method for Early Prognostication in Patients After Outofhospital Cardiac Arrest. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97639. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/brainstem-reflex-score-a-novel-method-for-early-prognostication-in-patients-after-outofhospital-cardiac-arrest/. Accessed June 19, 2019.

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