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    Patent Pending

    GO-FAR (Good Outcome Following Attempted Resuscitation) Score

    Predicts survival to discharge with good outcome after in-hospital cardiac arrest.
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    INSTRUCTIONS

    Use pre-arrest information to calculate.

    Pearls/Pitfalls
    Why Use

    Derived on registry-based data split into derivation and validation sets.

    Patients and families sometimes have unrealistic expectations of quality of life after surviving in-hospital cardiac arrest. The GO-FAR Score may help in discussions regarding code status and prognosis.

    <70
    0
    70-74
    +2
    75-79
    +5
    80-84
    +6
    ≥85
    +11
    No
    0
    Yes
    -15
    No
    0
    Yes
    +10
    No
    0
    Yes
    +8
    No
    0
    Yes
    +7
    No
    0
    Yes
    +7
    No
    0
    Yes
    +7
    No
    0
    Yes
    +6
    No
    0
    Yes
    +6
    No
    0
    Yes
    +5
    No
    0
    Yes
    +4
    No
    0
    Yes
    +4
    No
    0
    Yes
    +1

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights

    Advice

    Consider patient preferences and general medical prognosis in discussions of code status and aggressiveness of interventions.

    Formula

    Addition of the selected points:

    Variable

    Points

    Age, years

    <70

    0

    70-74

    2

    75-79

    5

    80-84

    6

    ≥85

    11

    Neurologically intact or with minimal deficits at admission

    -15

    Major trauma (injury associated with shock or altered mental status during current admission)

    10

    Acute stroke (ischemic or hemorrhagic stroke during current admission)

    8

    Metastatic or hematologic cancer

    7

    Septicemia (documented bloodstream infection with antibiotics not yet started or still ongoing)

    7

    Medical noncardiac diagnosis on admission

    7

    Hepatic insufficiency (total bilirubin >2 mg/dL or 34 µmol/L and AST >2x upper limit of normal, or cirrhosis)

    6

    Admit from skilled nursing facility

    6

    Hypotension or hypoperfusion within 4 hrs prior to arrest (SBP <90, MAP <60, pressors or inotropes other than dopamine ≤3 µmol/kg/min after volume expansion, or intra-aortic balloon pump)

    5

    Renal insufficiency or dialysis

    4

    Respiratory insufficiency within 4 hrs of arrest (any of the following: P/F ratio <300, PaO2 <60, SaO2 <90%; PaCO2, ETCO2, or transcutaneous CO2 >50, spontaneous RR >40 or <5, or noninvasive or invasive ventilation)

    4

    Pneumonia (documented active pneumonia with antibiotics not yet started or still ongoing)

    1

    Facts & Figures

    Interpretation:

    GO-FAR Score

    Risk group

    Survival to discharge with minimal neurologic disability*

    ≥24

    Very low survival

    <1%

    14 to 23

    Low survival

    1-3%

    -5 to 13

    Average survival

    3-15%

    -15 to -6

    Above average survival

    >15%

    *Defined as cerebral performance category of 1 or good cerebral performance (patient is conscious, alert, and able to work but might have mild neurologic or psychological deficits, such as mild dysphagia or minor cranial nerve abnormalities).

    Literature

    Dr. Mark H. Ebell

    From the Creator

    Why did you develop the GO-FAR Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

    As clinicians, we're not very good about routinely addressing DNR status with our hospitalized patients. As a result, many patients with a poor prognosis experience CPR and only rarely benefit. My goal was to be able to use information available on admission to identify patients at high risk for a poor outcome.

    What pearls, pitfalls and/or tips do you have for users of the GO-FAR Score? Do you know of cases when it has been applied, interpreted, or used inappropriately?

    The clinical decision rule is intended for use in inpatients, and should serve as a backup to clinical judgment and a value-based discussion with the patient about their goals for treatment. It is not a substitute for judgment, and has not been validated in outpatients or in the out of hospital setting.

    What recommendations do you have for doctors once they have applied the GO-FAR Score? Are there any adjustments or updates you would make to the score based on new data or practice changes?

    Increasing rates of survival to discharge with a good neurologic outcome may necessitate recalibration of the score. In a prospective validation study (currently in review), we found that increasing the cutoff for very low likelihood of a good outcome to 26+ points from 24+ points would classify 3,380 patients in this group, of whom 52 survive (1.5%); increasing it to 28+ points would classify 2,394 patients in this group, of whom 29 survive (1.2%).

    Any other research in the pipeline that you’re particularly excited about?

    We are working on a series of studies to attempt to validate decision support tools to help primary care physicians determine which patients with a respiratory infection need an antibiotic, and the much larger group that do not.

    About the Creator

    Mark H. Ebell, MD, MS, is a family practice physician and the director of epidemiology and biostatistics at the University of Georgia. He is a Robert Wood Johnson Generalist Physician Faculty Scholar and an editor at American Family Physician. Dr. Ebell is an expert on evidence-based medicine and point-of-care decision support, and has authored or co-authored over 200 peer-reviewed publications.

    To view Dr. Mark H. Ebell's publications, visit PubMed