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. 2020 Sep:154:26-30.
doi: 10.1016/j.resuscitation.2020.07.004. Epub 2020 Jul 13.

Data-driven classification of arrest location for emergency department cardiac arrests

Nancy Mikati  1 , Clifton W Callaway  1 , Patrick J Coppler  1 , Jonathan Elmer  2 ; University of Pittsburgh Post-Cardiac Arrest Service
Affiliations

Data-driven classification of arrest location for emergency department cardiac arrests

Nancy Mikati et al. Resuscitation. 2020 Sep.

Abstract

Background: Resuscitation research is inconsistent in how emergency department (ED) arrests are classified. We tested whether clinical features of ED arrests more closely resembled out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA).

Methods: We performed a retrospective study including all patients resuscitated from cardiac arrest at a single academic medical center from January 2010 to December 2019. We abstracted clinical information from our prospective registry. We used unsupervised learning (k-prototypes) to identify clusters within the OHCA and IHCA cohorts. We determined the number of subgroups using scree plots. We assigned individual ED arrest patients the nearest OHCA or IHCA cluster based on the shortest Gower distance from that patient to the nearest cluster center. In our secondary analysis, we determined the optimal number of clusters in each of the 3 arrest cohorts, and then calculated the mean Gower distances with the standard deviation (SD) between cluster centers (ED-IHCA, ED-OHCA, IHCA-OHCA).

Results: We included 2723 patients: 372 (14%) ED arrests, 1709 (63%) OHCA, and 642 (23%) IHCA. We identified 3 clusters of OHCA patients, and 4 clusters of IHCA patients. Of ED arrest cases, 292 (78%) most closely resembled an IHCA cluster and 80 (22%) most closely resembled an OHCA cluster. Mean (SD) Gower distance between ED arrest and IHCA centers was 0.33 (0.2). Mean Gower distances between ED arrest-OHCA centers and between IHCA-OHCA centers were 0.41 (0.11).

Conclusion: Across multiple aggregated measures, ED arrests resemble IHCA more than OHCA.

Keywords: Cardiac arrest; Clustering; Unsupervised learning.

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Conflict of interest statement

Conflict of interest statement: The authors have no disclosures or potential conflicts of interest to report.

Figures

Figure 1:
Figure 1:
Force directed plot showing pairwise distances between the 11 cluster centers. Clusters are colored by arrest location, and their size is proportional to the size of the cluster. Edges (connections between clusters) are weighted as the inverse of the Gower distance.
See this image and copyright information in PMC

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