External validation and comparative performance of ACLS, SARICA, NULL-PLEASE, BDR scores for in-hospital mortality after out-of-hospital cardiac arrest: a multicenter retrospective cohort study.

Authors

Chien-Tai Huang, Cheng-Yi Fan, Sih-Shiang Huang, Chun-Hsiang Huang, Yi-Ju Ho, Ching-Yu Chen, Tzu-Hsueh Wang, Chi-Hsin Chen, Wei-Tien Chang, Edward Pei-Chuan Huang, Chih-Wei Sung

Published in

Resuscitation plus. Volume 31. Pages 101424. Epub Jul 23, 2026.

Abstract

Prognostic scores are used to estimate outcomes after out-of-hospital cardiac arrest (OHCA), but their comparative performance in external cohorts remains unclear. We externally validated the ACLS, SARICA, NULL-PLEASE, and BDR scores for predicting in-hospital mortality after return of spontaneous circulation.
We conducted a retrospective multicenter cohort study using the OHCA Research Database. Adult patients with emergency medical services-attended OHCA who achieved return of spontaneous circulation were included. Patients without data required for score calculation, including brain computed tomography, blood gas analysis, or lactate measurement, were excluded. Discrimination, calibration, and diagnostic performance were assessed using area under the receiver operating characteristic curve, decile-based calibration plots, and standard diagnostic indices.
Among 1036 included patients, 718 (69.3%) died during hospitalization. The BDR score showed the highest discrimination for in-hospital mortality, with an area under the receiver operating characteristic curve of 0.775 (95% CI, 0.745-0.805), followed by NULL-PLEASE (0.756; 95% CI, 0.723-0.788), modified SARICA (0.746; 95% CI, 0.714-0.779), and modified ACLS (0.662; 95% CI, 0.627-0.697). BDR, NULL-PLEASE, and modified SARICA all significantly outperformed modified ACLS, whereas differences among these three scores were not statistically significant. At Youden-index thresholds, BDR demonstrated the highest sensitivity and negative predictive value, but specificity was only moderate across all models.
BDR, NULL-PLEASE, and modified SARICA demonstrated fair discrimination for in-hospital mortality after OHCA, whereas modified ACLS showed lower discrimination. Because clinically practical thresholds had limited specificity, these scores should be interpreted cautiously and used only as adjuncts to serial multimodal assessment.

PMID:
42597754
Bibliographic data and abstract were imported from PubMed on 14 Aug 2026.

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