Emergency Department Prognostication of Comatose Cardiac Arrest Patients Undergoing Therapeutic Hypothermia is Unreliable.

From the American Journal of Emergency Medicine:

Background

Therapeutic hypothermia (TH) improves patient survival with good neurologic outcome after cardiac arrest. The value of early clinician prognostication in the Emergency Department (ED) has not been studied in this patient population.

Objective

To determine if physicians can accurately predict survival and neurologic outcome at hospital discharge of resuscitated, comatose out-of-hospital cardiac arrest (OHCA) patients treated in a post-cardiac arrest (CA) clinical pathway that included TH.

Methods

This was a prospective, observational study conducted at a tertiary referral center. Participants were physicians involved in the resuscitation of OHCA patients treated with a clinical pathway that included TH. Immediately following patient resuscitation in the ED, physicians recorded their prediction of patient survival and neurologic outcome on a standardized questionnaire. Neurologic outcome was assessed by the cerebral performance category (CPC).

Results

Forty-two physicians completed questionnaires on 17 patients enrolled from October 2009 to March 2010 Sensitivity and specificity of physician prediction of patient survival was 0.67 (95%CI=0.45 to 0.83) and 0.82 (95%CI=0.59 to 0.94), respectively with AUC 0.74 (95% CI=0.61 to 0.88), +LR 3.72 (95% CI=1.30 to 11.02) and -LR 0.40 (95% CI=0.21 to 0.77). Sensitivity and specificity of physician prediction of good neurologic outcome was 0.40 (95%CI=0.20 to 0.64) and 0.69 (95%CI=0.50 to 0.84), respectively with AUC 0.55 (95%CI=0.39 to 0.70), +LR 1.29 (95% CI=0.56 to 3.03) and -LR 0.87 (95% CI=0.53 to 1.41).

Conclusions

Physicians poorly prognosticate both survival and neurologic outcome in comatose OHCA patients undergoing TH. Premature prognostication in the ED is unreliable and should be avoided.

Ebola nurse to sue Dallas hospital parent company over training, privacy concerns

From the Washington Post:

A 26-year-old nurse who contracted Ebola while caring for a patient says she plans to sue, alleging privacy issues and a failure to properly train the Texas hospital’s staff, the Dallas Morning News reports.

“I wanted to believe that they would have my back and take care of me, but they just haven’t risen to the occasion,” Nina Pham told the newspaper.

The Morning News reports that Pham on Monday will file suit against Texas Health Resources, the parent company of Texas Health Presbyterian Hospital Dallas. She claims that personnel at the hospital didn’t have the gear or resources to deal with Ebola and didn’t get enough instruction for care or treatment.