A Comparison of the Ability of Morbidity Scores to Predict
Unsuccessful Cardiopulmonary Resuscitation in Thailand
Panita Limpawattana MD1, Chomchanok Suraditnan MD2, Wannaporn Aungsakul MD2, Anupol Panitchote MD3,
Boonsong Patjanasoontorn MD3, Anakapong Phunmanee MD3, Nittaya Pittayawattanachai MD4
Affiliation :
1 Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
2 Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
3 Division of Critical care, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
4 CPR Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background : Pre-arrest morbidity [PAM] scores could be used as additional tools to help patients and healthcare providers make
decisions regarding do not resuscitate [DNR] orders. There are, however, no studies that examine applicability of those scores in
Thailand.
Objective : To compare the usefulness of mortality prediction scores at hospital discharge among cardiac arrest patients who received
cardiopulmonary resuscitation [CPR] and to identify the optimal cutoff points of the best morbidity scores.
Materials and Methods : A retrospective chart review was conducted of all adult patients who underwent CPR from January 1, 2013
to December 31, 2014 at Srinagarind Hospital, Thailand. Demographic and clinical data to calculate the PAM score, the prognosis
after resuscitation [PAR] score, and the modi(cid:976)ied PAM index [MPI] were collected.
Results : There were enough data available on one-hundred and ninety-two patients to analyze the outcomes. The overall
performances of all morbidity scores according to the area under the receiver operating characteristic [ROC] curves were similar;
PAM 0.65 (95% con(cid:976)idence interval [CI] 0.56 to 0.74), MPI 0.66 (95% CI 0.57 to 0.75), and PAR 0.6 (95% CI 0.52 to 0.70), p = 0.5.
PAM ≥6 and MPI ≥5 were the optimal cutoff points, which provided sensitivities of 49% and 57%, respectively, and speci(cid:976)icities of
80.5% and 73.2%, respectively.
Conclusion : PAM, MPI, and PAR scores are not suf(cid:976)icient tools to identify patients who would bene(cid:976)it from resuscitation attempts
among Thai patients. Given their high speci(cid:976)icities, a combination these tools as part of a shared-decision to identify patients in
whom CPR is likely to be unsuccessful recommended.
Keywords : Cardiac arrest, CPR, PAM, PAR, Prognosis, MPI, Survival
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