• Matthew Henry, Stephanie L Filipp, AydinElber YukselEYCollege of Medicine, Department of Pediatrics, Critical Care Medicine, University of Florida-Jacksonville, United States., Nicolas Chiriboga, Kailea Zelinka, SmithLorena EspinosaLEChildren's Hospital Los Angeles, Department of Anesthesiology Critical Care Medicine, United States., Matthew J Gurka, Jose Irazuzta, Yudy Fonseca, Meredith C Winter, Charlene Pringle, and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.
• College of Medicine, Department of Pediatrics, Critical Care Medicine, University of Florida, PO Box 100296, Gainesville, FL 32610, United States. Electronic address: mhenry2@ufl.edu.
• Resuscitation. 2023 Apr 1; 185: 109727109727.

AimOut-of-hospital cardiac arrest (OHCA) in pediatric patients is associated with high rates of mortality and neurologic injury, with no definitive evidence-based method to predict outcomes available. A prognostic scoring tool for adults, The Brain Death After Cardiac Arrest (BDCA) score, was recently developed and validated. We aimed to validate this score in pediatric patients.MethodsRetrospective cohort study of pediatric patients admitted to 5 PICUs after OHCA between 2011 and 2021. We extracted BDCA score elements for those who survived at least 24 hours but died as a result of their OHCA. We assessed score discrimination for the definitive outcome of brain death. Subgroup analysis was performed for infants < 12mo versus children ≥ 12mo, those who likely had brain death but had withdrawal of life sustaining therapy (WLST) prior to declaration, and by etiology and duration of arrest.Results389 subjects were identified across 5 institutions, with 282 meeting inclusion criteria. 169 (59.9%) were formally declared brain dead; 58 (20.6%) had findings consistent with brain death but had withdrawal of life sustaining therapies prior to completion of formal declaration. Area under the receiver operating characteristic curve for the age ≥ 12mo cohort was 0.82 [95% CI 0.75, 0.90], which mirrored the adult subject AUCs of 0.82 [0.77, 0.86] and 0.81 [0.76, 0.86] in the development and validation cohorts. Scores demonstrated worse discrimination in the infant cohort (AUC = 0.61).ConclusionsThe BDCA score shows promise in children ≥ 12mo following OHCA and may be considered in conjunction with existing multimodal prognostication approaches.Copyright © 2023 Elsevier B.V. All rights reserved.

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