Validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) score in an East Asian population.

AIM: The Good Outcome Following Attempted Resuscitation (GO-FAR) score is useful for identifying patients post-arrest with very poor neurologic outcomes and may thus be utilized when counseling family members on do-not-attempt-resuscitation (DNAR) order. We validated the GO-FAR score for neurologically intact survival in patients with in-hospital cardiac arrest (IHCA) in an East Asian country in which DNAR order not common. METHODS: Retrospective study about patients who experienced IHCA from 2013 to 2017 with a primary outcome of neurologically intact survival, defined as a CPC score 1 or 2 at discharge. GO-FAR score categorizes the patients into 4 groups: a very low (<1%), low (1%-3%), average (>3%-15%), or higher than average (>15%) likelihood of neurologically intact survival. RESULTS: Of the 1011 included patients, the rates of survival discharge and neurologically intact survival at discharge were 25.4% and 16.0%, respectively. The area under the receiver operating characteristics curve of GO-FAR score for good neurological outcome was 0.81 (95% CI, 0.78-0.84). Patients with low or very low probability of survival had a likelihood of 0.9% (95% CI, 0.0-2.0), but for those under 40 years old, it was increased to 4.2% (95% CI, 0.0-12.2). Patients with average or above-average probabilities had likelihoods of of 18.5% (95% CI, 15.3-21.6) and 50.5% (95% CI, 40.6-60.5), respectively. CONCLUSIONS: The GO-FAR score well-predicted the neurologically intact survival of East Asian patients with IHCA. This tool may be used as part of a shared decision regarding DNAR orders.

Recommendations for therapeutic decisions of angiosarcoma of the scalp and face.

The aim of this study was to elucidate the therapeutic decision process of angiosarcoma of the scalp and face including treatment modalities, tumor size, tumor grade, and resection margins. In a PubMed search, 170 abstracts were read and 32 full text articles were reviewed. Among them, 19 articles were analyzed. Overall, survival did not differ significantly between the surgery group (23.6 ±â€Š11.0 months) and the no surgery group (22.2 ±â€Š8.0 months) (P = 0.386 [t test]). Among the patients who had undergone an operation, 64.4% had residual cancer cells at their surgical margin. Survival did not differ significantly according to the positive or negative resection margin (P > 0.05 [t tests]). Overall survival of the radiation therapy and chemotherapy group (37.0 ±â€Š0.0 months) was significantly longer than that of the radiation therapy group (22.7 ±â€Š7.6 months) or the chemotherapy group (15.1 ±â€Š4.6 months). Overall survival, local recurrence-free survival, and distant metastasis-free survival were significantly longer in the T1 group (the tumor size being the same or smaller than 5  cm) than the T2 group (tumor larger than 5  cm) (P < 0.05 [t test]). The 2-year survival rates and the 5-year survival rates were significantly longer in the T1 group than in the T2 group (P < 0.000 [t test]). The overall survival of low grade tumor group (44.8 ±â€Š10.4 months) was more than 2 times longer than the high-grade tumor group (22.3 ±â€Š6.8 months) (P = 0.000 [t test]). Surgeons should remember that they do not have to try to remove all the cancer cells in the operation theater. A combination of radiation and chemotherapy can bring better results than any single regimen. Lastly, early diagnosis and early treatment are essential.