• Kasper G Lauridsen, Therese Djärv, Jan Breckwoldt, Janice A Tjissen, Keith Couper, Robert Greif, and Education, Implementation and Team Task Force of the International Liaison Committee on Resuscitation (ILCOR).
• Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Emergency Department, Randers Regional Hospital, Randers, Denmark; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA. Electronic address: kglerup@clin.au.dk.
• Resuscitation. 2022 Oct 1; 179: 141-151.

AimTo evaluate the test accuracy of pre-arrest clinical decision tools for in-hospital cardiac arrest survival outcomes.MethodsWe searched Medline, Embase, and Cochrane Library from inception through January 2022 for randomized and non-randomized studies. We used the Quality Assessment of Diagnostic Accuracy Studies framework to evaluate risk of bias, and Grading of Recommendations Assessment, Development and Evaluation methodology to evaluate certainty of evidence. We report sensitivity, specificity, positive predictive outcome, and negative predictive outcome for prediction of survival outcomes. PROSPERO CRD42021268005.ResultsWe searched 2517 studies and included 23 studies using 13 different scores: 12 studies investigating 8 different scores assessing survival outcomes and 11 studies using 5 different scores to predict neurological outcomes. All were historical cohorts/ case control designs including adults only. Test accuracy for each score varied greatly. Across the 12 studies investigating 8 different scores assessing survival to hospital discharge/ 30-day survival, the negative predictive values (NPVs) for the prediction of survival varied from 55.6% to 100%. The GO-FAR score was evaluated in 7 studies with NPVs for survival with cerebral performance category (CPC) 1 ranging from 95.0% to 99.2%. Two scores assessed survival with CPC ≤ 2 and these were not externally validated. Across all prediction scores, certainty of evidence was rated as very low.ConclusionsWe identified very low certainty evidence across 23 studies for 13 different pre-arrest prediction scores to outcome following IHCA. No score was sufficiently reliable to support its use in clinical practice. We identified no evidence for children.Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

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