Tetsuhisa Kitamura1, Kosuke Kiyohara2, Masahiko Nitta3, Vinay M Nadkarni4, Robert A Berg4, Taku Iwami5. 1. Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Ymamada-oka, Suita 565-0871, Osaka, Japan. Electronic address: lucky_unatan@yahoo.co.jp. 2. Division Department of Public Health, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku 162-8666, Tokyo, Japan. 3. Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City 569-8686, Osaka, Japan. 4. Department of Anesthesia and Critical Care Medicine and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA. 5. Kyoto University Health Services, Yoshida-Honmachi, Sakyo-ku 606-8501, Kyoto, Japan.
Abstract
BACKGROUND: The relationship between survival rate following pediatric out-of-hospital cardiac arrests (OHCAs) and time of day or day of week is unknown. METHODS: A nationwide, prospective, population-based observational investigation of consecutive witnessed pediatric OHCAs (<18 years) with resuscitation attempts was conducted from January 2005 to December 2011. Days were defined as 9:00 am to 4:59 pm, nights as 5:00 pm to 8:59 am, weekdays as Mondays to Fridays, and weekends as Saturdays, Sundays, and national holidays. Primary outcome was one-month survival and secondary outcome was survival with favorable neurologic outcome, defined as cerebral performance category 1 or 2. RESULTS: A total of 3278 bystander-witnessed pediatric OHCAs were registered. One month survival rate was significantly lower during nights than days (15.5% [95% CI: 13.8-17.2%] versus 23.3% [95% CI: 21.1-25.6%]; P<0.001 and during weekends/holidays (15.7% [95% CI: 13.6-18.0%] than weekdays (20.4% [95% CI: 18.7-22.2%]; P=0.001. Survival rate with favorable neurologic outcome was substantially lower during nights 7.5% [95% CI: 6.3-8.8%] than days (12.2% [95% CI: 10.6-14.1%]; P<0.001), and during weekends/holidays (7.7% [95% CI: 6.2-9.5%] than weekdays (10.4% [95% CI: 9.2-11.8%]; P=0.012). After adjusting for potential confounding factors, one-month survival rate remained significantly lower during nights compared to days (odds ratio 0.68; 95% CI: 0.56-0.82), and during weekends/holidays compared to weekdays (odds ratio 0.79; 95% CI, 0.65-0.97). CONCLUSIONS: One-month survival rate following bystander-witnessed pediatric OHCAs was lower during nights and weekends/holidays than days and weekdays, even when adjusted for potentially confounding factors.
BACKGROUND: The relationship between survival rate following pediatric out-of-hospital cardiac arrests (OHCAs) and time of day or day of week is unknown. METHODS: A nationwide, prospective, population-based observational investigation of consecutive witnessed pediatric OHCAs (<18 years) with resuscitation attempts was conducted from January 2005 to December 2011. Days were defined as 9:00 am to 4:59 pm, nights as 5:00 pm to 8:59 am, weekdays as Mondays to Fridays, and weekends as Saturdays, Sundays, and national holidays. Primary outcome was one-month survival and secondary outcome was survival with favorable neurologic outcome, defined as cerebral performance category 1 or 2. RESULTS: A total of 3278 bystander-witnessed pediatric OHCAs were registered. One month survival rate was significantly lower during nights than days (15.5% [95% CI: 13.8-17.2%] versus 23.3% [95% CI: 21.1-25.6%]; P<0.001 and during weekends/holidays (15.7% [95% CI: 13.6-18.0%] than weekdays (20.4% [95% CI: 18.7-22.2%]; P=0.001. Survival rate with favorable neurologic outcome was substantially lower during nights 7.5% [95% CI: 6.3-8.8%] than days (12.2% [95% CI: 10.6-14.1%]; P<0.001), and during weekends/holidays (7.7% [95% CI: 6.2-9.5%] than weekdays (10.4% [95% CI: 9.2-11.8%]; P=0.012). After adjusting for potential confounding factors, one-month survival rate remained significantly lower during nights compared to days (odds ratio 0.68; 95% CI: 0.56-0.82), and during weekends/holidays compared to weekdays (odds ratio 0.79; 95% CI, 0.65-0.97). CONCLUSIONS: One-month survival rate following bystander-witnessed pediatric OHCAs was lower during nights and weekends/holidays than days and weekdays, even when adjusted for potentially confounding factors.
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