Ericka L Fink1, David K Prince2, Jonathan R Kaltman3, Dianne L Atkins4, Michael Austin5, Craig Warden6, Jamie Hutchison7, Mohamud Daya8, Scott Goldberg9, Heather Herren2, Janice A Tijssen10, James Christenson11, Christian Vaillancourt12, Ronna Miller9, Robert H Schmicker2, Clifton W Callaway13. 1. Division of Pediatric Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Faculty Pavilion, 2nd Floor, Pittsburgh, PA 15224, USA. Electronic address: finkel@ccm.upmc.edu. 2. Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, USA. 3. Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA. 4. Stead Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA. 5. Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada. 6. Oregon Health & Science University Doernbecher Children's Hospital, Portland, OR, USA. 7. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. 8. Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA. 9. Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. 10. Division of Pediatric Critical Care Medicine, Department of Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada. 11. Department of Emergency Medicine, University of British Columbia, Vancouver, Canada. 12. Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada. 13. Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Abstract
AIM: Outcomes for pediatric out-of-hospital cardiac arrest (OHCA) are poor. Our objective was to determine temporal trends in incidence and mortality for pediatric OHCA. METHODS: Adjusted incidence and hospital mortality rates of pediatric non-traumatic OHCA patients from 2007-2012 were analyzed using the 9 region Resuscitation Outcomes Consortium-Epidemiological Registry (ROC-Epistry) database. Children were divided into 4 age groups: perinatal (<3 days), infants (3days-1year), children (1-11 years), and adolescents (12-19 years). ROC regions were analyzed post-hoc. RESULTS: We studied 1738 children with OHCA. The age- and sex-adjusted incidence rate of OHCA was 8.3 per 100,000 person-years (75.3 for infants vs. 3.7 for children and 6.3 for adolescents, per 100,000 person-years, p<0.001). Incidence rates differed by year (p<0.001) without overall linear trend. Annual survival rates ranged from 6.7-10.2%. Survival was highest in the perinatal (25%) and adolescent (17.3%) groups. Stratified by age group, survival rates over time were unchanged (all p>0.05) but there was a non-significant linear trend (1.3% increase) in infants. In the multivariable logistic regression analysis, infants, unwitnessed event, initial rhythm of asystole, and region were associated with worse survival, all p<0.001. Survival by region ranged from 2.6-14.7%. Regions with the highest survival had more cases of EMS-witnessed OHCA, bystander CPR, and increased EMS-defibrillation (all p<0.05). CONCLUSIONS: Overall incidence and survival of children with OHCA in ROC regions did not significantly change over a recent 5year period. Regional variation represents an opportunity for further study to improve outcomes.
AIM: Outcomes for pediatric out-of-hospital cardiac arrest (OHCA) are poor. Our objective was to determine temporal trends in incidence and mortality for pediatric OHCA. METHODS: Adjusted incidence and hospital mortality rates of pediatric non-traumatic OHCApatients from 2007-2012 were analyzed using the 9 region Resuscitation Outcomes Consortium-Epidemiological Registry (ROC-Epistry) database. Children were divided into 4 age groups: perinatal (<3 days), infants (3days-1year), children (1-11 years), and adolescents (12-19 years). ROC regions were analyzed post-hoc. RESULTS: We studied 1738 children with OHCA. The age- and sex-adjusted incidence rate of OHCA was 8.3 per 100,000 person-years (75.3 for infants vs. 3.7 for children and 6.3 for adolescents, per 100,000 person-years, p<0.001). Incidence rates differed by year (p<0.001) without overall linear trend. Annual survival rates ranged from 6.7-10.2%. Survival was highest in the perinatal (25%) and adolescent (17.3%) groups. Stratified by age group, survival rates over time were unchanged (all p>0.05) but there was a non-significant linear trend (1.3% increase) in infants. In the multivariable logistic regression analysis, infants, unwitnessed event, initial rhythm of asystole, and region were associated with worse survival, all p<0.001. Survival by region ranged from 2.6-14.7%. Regions with the highest survival had more cases of EMS-witnessed OHCA, bystander CPR, and increased EMS-defibrillation (all p<0.05). CONCLUSIONS: Overall incidence and survival of children with OHCA in ROC regions did not significantly change over a recent 5year period. Regional variation represents an opportunity for further study to improve outcomes.
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