Mathias J Holmberg1,2, Ari Moskowitz3, Tia T Raymond4, Robert A Berg5,6,7, Vinay M Nadkarni5,6,7, Alexis A Topjian5,6,7, Anne V Grossestreuer1, Michael W Donnino1,3, Lars W Andersen1,2. 1. Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA. 2. Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark. 3. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. 4. Division of Cardiac Critical Care, Department of Pediatrics, Medical City Children's Hospital, Dallas, TX. 5. Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA. 6. Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 7. Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Abstract
OBJECTIVES: To develop a clinical prediction score for predicting mortality in children following return of spontaneous circulation after in-hospital cardiac arrest. DESIGN: Observational study using prospectively collected data. SETTING: This was an analysis using data from the Get With The Guidelines-Resuscitation registry between January 2000 and December 2015. PATIENTS: Pediatric patients (< 18 yr old) who achieved return of spontaneous circulation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was in-hospital mortality. Patients were divided into a derivation (3/4) and validation (1/4) cohort. A prediction score was developed using a multivariable logistic regression model with backward selection. Patient and event characteristics for the derivation cohort (n = 3,893) and validation cohort (n = 1,297) were similar. Seventeen variables associated with the outcome remained in the final reduced model after backward elimination. Predictors of in-hospital mortality included age, illness category, pre-event characteristics, arrest location, day of the week, nonshockable pulseless rhythm, duration of chest compressions, and interventions in place at time of arrest. The C-statistic for the final score was 0.77 (95% CI, 0.75-0.78) in the derivation cohort and 0.77 (95% CI, 0.74-0.79) in the validation cohort. The expected versus observed mortality plot indicated good calibration in both the derivation and validation cohorts. The score showed a stepwise increase in mortality with an observed mortality of less than 15% for scores 0-9 and greater than 80% for scores greater than or equal to 25. The model also performed well for neurologic outcome and in sensitivity analyses for events within the past 5 years and for patients with or without a pulse at the onset of chest compressions. CONCLUSIONS: We developed and internally validated a prediction score for initial survivors of pediatric in-hospital cardiac arrest. This prediction score may be useful for prognostication following cardiac arrest, stratifying patients for research, and guiding quality improvement initiatives.
OBJECTIVES: To develop a clinical prediction score for predicting mortality in children following return of spontaneous circulation after in-hospital cardiac arrest. DESIGN: Observational study using prospectively collected data. SETTING: This was an analysis using data from the Get With The Guidelines-Resuscitation registry between January 2000 and December 2015. PATIENTS: Pediatric patients (< 18 yr old) who achieved return of spontaneous circulation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was in-hospital mortality. Patients were divided into a derivation (3/4) and validation (1/4) cohort. A prediction score was developed using a multivariable logistic regression model with backward selection. Patient and event characteristics for the derivation cohort (n = 3,893) and validation cohort (n = 1,297) were similar. Seventeen variables associated with the outcome remained in the final reduced model after backward elimination. Predictors of in-hospital mortality included age, illness category, pre-event characteristics, arrest location, day of the week, nonshockable pulseless rhythm, duration of chest compressions, and interventions in place at time of arrest. The C-statistic for the final score was 0.77 (95% CI, 0.75-0.78) in the derivation cohort and 0.77 (95% CI, 0.74-0.79) in the validation cohort. The expected versus observed mortality plot indicated good calibration in both the derivation and validation cohorts. The score showed a stepwise increase in mortality with an observed mortality of less than 15% for scores 0-9 and greater than 80% for scores greater than or equal to 25. The model also performed well for neurologic outcome and in sensitivity analyses for events within the past 5 years and for patients with or without a pulse at the onset of chest compressions. CONCLUSIONS: We developed and internally validated a prediction score for initial survivors of pediatric in-hospital cardiac arrest. This prediction score may be useful for prognostication following cardiac arrest, stratifying patients for research, and guiding quality improvement initiatives.
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