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. 2014 Jul;7(4):517-23.
doi: 10.1161/CIRCOUTCOMES.113.000691.

Hospital variation in survival after pediatric in-hospital cardiac arrest

Natalie Jayaram, John A Spertus, Vinay Nadkarni, Robert A Berg, Fengming Tang, Tia Raymond, Anne-Marie Guerguerian, Paul S Chan; American Heart Association's Get with the Guidelines-Resuscitation Investigators

Hospital variation in survival after pediatric in-hospital cardiac arrest

Natalie Jayaram et al. Circ Cardiovasc Qual Outcomes. 2014 Jul.

Abstract

Background: Although survival after in-hospital cardiac arrest is likely to vary among hospitals caring for children,validated methods to risk-standardize pediatric survival rates across sites do not currently exist.

Methods and results: From 2006 to 2010, within the American Heart Association's Get With the Guidelines-Resuscitation registry for in-hospital cardiac arrest, we identified 1551 cardiac arrests in children (<18 years). Using multivariable hierarchical logistic regression, we developed and validated a model to predict survival to hospital discharge and calculated risk-standardized rates of cardiac arrest survival for hospitals with a minimum of 10 pediatric cardiac arrest cases. A total of 13 patient-level predictors were identified: age, sex, cardiac arrest rhythm, location of arrest, mechanical ventilation, acute nonstroke neurological event, major trauma, hypotension, metabolic or electrolyte abnormalities, renal insufficiency, sepsis, illness category, and need for intravenous vasoactive agents prior to the arrest. The model had good discrimination (C-statistic of 0.71), confirmed by bootstrap validation (validation C-statistic of 0.69). Among 30 hospitals with ≥10 cardiac arrests, unadjusted hospital survival rates varied considerably (median, 37%; interquartile range, 24-42%; range, 0-61%). After risk-standardization, the range of hospital survival rates narrowed (median, 37%; interquartile range, 33-38%; range, 29-48%), but variation in survival persisted.

Conclusions: Using a national registry, we developed and validated a model to predict survival after in-hospital cardiac arrest in children. After risk-standardization, significant variation in survival rates across hospitals remained. Leveraging these models, future studies can identify best practices at high-performing hospitals to improve survival outcomes for pediatric cardiac arrest. (

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Figures

Figure 1
Figure 1. Calibration of the Final Model in the Derivation Cohort
The model showed excellent calibration, with slope of 1.1 (slope of 1.0 for perfect calibration).
Figure 2
Figure 2
Unadjusted (Fig. 2a) and Risk-Standardized (Fig. 2b) Hospital Survival Rates for In-Hospital Cardiac Arrest
See this image and copyright information in PMC

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