• Nan Liu, Jan Wnent, LeeJin WeeJWHealth Services and Systems Research, Duke-NUS Medical School, Singapore; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore., Yilin Ning, HoAndrew Fu WahAFWHealth Services and Systems Research, Duke-NUS Medical School, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore., Fahad Javaid Siddiqui, Shir Lynn Lim, Michael Yih-Chong Chia, Ling Tiah, Desmond Ren-Hao Mao, Jan-Thorsten Gräsner, OngMarcus Eng HockMEHHealth Services and Systems Research, Duke-NUS Medical School, Singapore; Health Services Research Centre, Singapore Health Services, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore; Prehospital Emer, PAROS Singapore Investigators, Han Nee Gan, Si Oon Cheah, Wei Ming Ng, Wei Ling Tay, LeongBenjamin S HBSHNational University Hospital, Singapore., Gayathri Nadarajan, DoctorNausheen EdwinNESengkang General Hospital, Singapore., Lai Peng Tham, and Shalini Arulanandam.
• Health Services and Systems Research, Duke-NUS Medical School, Singapore; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore; Health Services Research Centre, Singapore Health Services, Singapore; SingHealth AI Health Program, Singapore Health Services, Singapore; Institute of Data Science, National University of Singapore, Singapore. Electronic address: liu.nan@duke-nus.edu.sg.
• Resuscitation. 2022 Jul 1; 176: 42-50.

BackgroundSurvival with favorable neurological outcomes is an important indicator of successful resuscitation in out-of-hospital cardiac arrest (OHCA). We sought to validate the CaRdiac Arrest Survival Score (CRASS), derived using data from the German Resuscitation Registry, in predicting the likelihood of good neurological outcomes after OHCA in Singapore.MethodsWe conducted a retrospective population-based validation study among EMS-attended OHCA patients (≥18 years) in Singapore, using data from the prospective Pan-Asian Resuscitation Outcomes Study registry. Good neurological outcome was defined as a cerebral performance category of 1 or 2. To evaluate the CRASS score in light of the difference in patient characteristics, we used the default constant coefficient (0.8) and the adjusted coefficient (0.2) to calculate the probability of good neurological outcomes.ResultsOut of 11,404 analyzed patients recruited between April 2010 and December 2018, 260 had good and 11,144 had poor neurological function. The CRASS score demonstrated good discrimination, with an area under the curve of 0.963 (95% confidence interval: 0.952-0.974). Using the default constant coefficient of 0.8, the CRASS score consistently overestimated the predicted probability of a good outcome. Following adjustment of the coefficient to 0.2, the CRASS score showed improved calibration.ConclusionCRASS demonstrated good discrimination and moderate calibration in predicting favorable neurological outcomes in the validation Singapore cohort. Our study established a good foundation for future large-scale, cross-country validations of the CRASS score in diverse sociocultural, geographical, and clinical settings.Copyright © 2022 Elsevier B.V. All rights reserved.

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