Punkaj Gupta1, Xinyu Tang2, Christine M Gall3, Casey Lauer3, Tom B Rice4, Randall C Wetzel5. 1. Division of Pediatric Critical Care, Department of Pediatrics, University of Arkansas Medical Center, Little Rock, AR, United States; Division of Pediatric Cardiology, Department of Pediatrics, University of Arkansas Medical Center, Little Rock, AR, United States. Electronic address: pgupta2@uams.edu. 2. Division of Biostatistics, Department of Pediatrics, University of Arkansas Medical Center, Little Rock, AR, United States. 3. Virtual PICU Systems, LLC, Los Angeles, CA, United States. 4. Virtual PICU Systems, LLC, Los Angeles, CA, United States; Division of Pediatric Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States. 5. Virtual PICU Systems, LLC, Los Angeles, CA, United States; Division of Critical Care Medicine, Department of Pediatrics and Anesthesiology, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA, United States.
Abstract
OBJECTIVE: To describe epidemiology and outcomes associated with cardiac arrest among critically ill children across hospitals of varying center volumes. METHODS: Patients <18 years of age in the Virtual PICU Systems (VPS, LLC) Database (2009-2013) were included. Patients with both cardiac and non-cardiac diagnoses were included. Data on demographics, patient diagnosis, cardiac arrest, severity of illness and outcomes were collected. Hierarchical cluster analysis was performed to categorize all the participating centers into low, low-medium, high-medium, and high volume groups using the center volume characteristics (annual hospital discharges per center, annual extracorporeal membrane oxygenation per center, and annual mechanical ventilators per center). Multivariable models were used to evaluate association of center volume with incidence of cardiac arrest, and mortality after cardiac arrest, adjusting for patient and center characteristics. RESULTS: Of 329,982 patients (108 centers), 2.2% (n=7390) patients had cardiac arrest with an associated mortality of 35% (n=2586). In multivariable models controlling for patient and center characteristics, center volume was not associated with either the incidence of cardiac arrest (OR: 1.00; 95% CI: 0.95-1.06; p=0.98), or mortality in those with cardiac arrest (OR: 0.93; 95% CI: 0.82-1.06; p=0.27). These associations were similar across cardiac and non-cardiac disease categories. Furthermore, we demonstrated that there was no correlation between incidence of cardiac arrest and mortality in those with cardiac arrest across different study hospitals in adjusted models. CONCLUSIONS: Both incidence of cardiac arrest, and mortality in those with cardiac arrest vary substantially across hospitals. However, center volume is not associated with either of these outcomes, after adjusting for patient and center characteristics.
OBJECTIVE: To describe epidemiology and outcomes associated with cardiac arrest among critically ill children across hospitals of varying center volumes. METHODS:Patients <18 years of age in the Virtual PICU Systems (VPS, LLC) Database (2009-2013) were included. Patients with both cardiac and non-cardiac diagnoses were included. Data on demographics, patient diagnosis, cardiac arrest, severity of illness and outcomes were collected. Hierarchical cluster analysis was performed to categorize all the participating centers into low, low-medium, high-medium, and high volume groups using the center volume characteristics (annual hospital discharges per center, annual extracorporeal membrane oxygenation per center, and annual mechanical ventilators per center). Multivariable models were used to evaluate association of center volume with incidence of cardiac arrest, and mortality after cardiac arrest, adjusting for patient and center characteristics. RESULTS: Of 329,982 patients (108 centers), 2.2% (n=7390) patients had cardiac arrest with an associated mortality of 35% (n=2586). In multivariable models controlling for patient and center characteristics, center volume was not associated with either the incidence of cardiac arrest (OR: 1.00; 95% CI: 0.95-1.06; p=0.98), or mortality in those with cardiac arrest (OR: 0.93; 95% CI: 0.82-1.06; p=0.27). These associations were similar across cardiac and non-cardiac disease categories. Furthermore, we demonstrated that there was no correlation between incidence of cardiac arrest and mortality in those with cardiac arrest across different study hospitals in adjusted models. CONCLUSIONS: Both incidence of cardiac arrest, and mortality in those with cardiac arrest vary substantially across hospitals. However, center volume is not associated with either of these outcomes, after adjusting for patient and center characteristics.
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