• Winchana Srivilaithon, Kumpol Amnuaypattanapon, Chitlada Limjindaporn, Intanon Imsuwan, Kiattichai Daorattanachai, Ittabud Dasanadeba, and Yaowapha Siripakarn.
• Department of Emergency Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
• Emerg Med Australas. 2019 Oct 1; 31 (5): 843-850.

ObjectiveThis study describes the predictors of in-hospital cardiac arrest (IHCA) within 24 h of ED triage and evaluates their ability to predict patients at risk of IHCA.MethodsA case-control study was conducted in the ED. 'Cases' are herein defined as hospitalised patients who experienced IHCA within 24 h after ED triage. The exclusion criteria were those younger than 16 years old, cases of traumatic arrest, or had do-not-resuscitate orders. The controls were adults, non-traumatic cases, who did not experience IHCA within 24 h of ED triage. A multivariable regression model was used to identify significant predictors of IHCA. The ability to discriminate was quantified by utilising an area under receiver operating characteristic (AuROC) curve.ResultsTwo hundred and fifty IHCAs were compared with 1000 controls. Five predictors emerged that were: higher National Early Warning Score (NEWS) at triage, equal or increase of NEWS after ED management, coronary artery disease as a comorbid disease, the use of a vasoactive agent, and initial serum bicarbonate level lower than 23.5 mmoL/L, independently associated with IHCA. The AuROC of the final model from all predictors was 0.91 (95% CI 0.89-0.93) higher than NEWS alone model (AuROC at 0.78, 95% CI 0.74-0.81).ConclusionsWe conclude that a combination of NEWS and four independent predictors identify patients at risk of IHCA more effectively than NEWS alone.© 2019 Australasian College for Emergency Medicine.

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