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Abstract
Objective To implement a standardized approach to characterize neurologic outcomes among 12-month survivors in the Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) trials.
Methods Two multicenter trials enrolled children age 48 hours to 18 years who remained comatose after cardiac arrest (CA) occurring out-of-hospital (THAPCA-OH, NCT00878644) or in-hospital (THAPCA-IH, NCT00880087); patients were randomized to therapeutic hypothermia or therapeutic normothermia. The primary outcome, survival with favorable 12-month neurobehavioral outcome (Vineland Adaptive Behavior Scales [VABS-II]), did not differ between treatment groups in either trial. Neurologists examined 181 12-month survivors, described findings using the novel semi-quantitative Pediatric Resuscitation after Cardiac Arrest (PRCA) form, and rated findings in 6 domains; scores ranged from 0 (no deficits) to 21 (maximal deficits). PRCA scores were compared with 12-month VABS-II scores and cognitive scores.
Results Neurologic outcome PRCA scores were classified as no/minimal impairment, PRCA 0–3, 81/179 (45%); mild impairment, PRCA 4–7, 24/179 (13%); moderate impairment, PRCA 8–11, 15/179 (8%); severe impairment, PRCA 12–16, 20/179 (11%); profound impairment, PRCA 17–21, 39/179 (21%) (2/181 incomplete). VABS-II scores correlated strongly with PRCA category (r = −0.88, p < 0.0001, Pearson correlation coefficient) and cognitive scores (r = −0.72, p < 0.0001). Factors associated with poor outcomes included out-of-hospital CA, seizure recognition in the early postarrest period, and poor neurologic status at hospital discharge.
Conclusion The PRCA provides a robust method for depicting neurologic outcomes after acute encephalopathy caused by CA in children. It provides a global semiquantitative rating of neurologic impairment and domain-specific impairment. The strong correlation with well-established neurobehavioral outcome measures supports its validity over a broad age range and wide spectrum of outcomes.
Glossary
- CA=
- cardiac arrest;
- DCC=
- Data Coordinating Center;
- PCPC=
- Pediatric Cerebral Performance Category;
- POPC=
- Pediatric Overall Performance Category;
- PRCA=
- Pediatric Resuscitation after Cardiac Arrest;
- PSOM=
- Pediatric Stroke Outcome Measure;
- THAPCA=
- Therapeutic Hypothermia After Pediatric Cardiac Arrest;
- VABS-II=
- Vineland Adaptive Behavior Scales, Second Edition;
- WASI=
- Wechsler Abbreviated Scale of Intelligence
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Coinvestigators are listed at links.lww.com/WNL/A574
CME Course: NPub.org/cmelist
- Received November 24, 2017.
- Accepted in final form April 9, 2018.
- © 2018 American Academy of Neurology
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