一项关于医院因素与心脏骤停后死亡率之间关系的全国性分析。
A national analysis of the relationship between hospital factors and post-cardiac arrest mortality.
作者信息
Carr Brendan G, Goyal Munish, Band Roger A, Gaieski David F, Abella Benjamin S, Merchant Raina M, Branas Charles C, Becker Lance B, Neumar Robert W
机构信息
The Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA.
出版信息
Intensive Care Med. 2009 Mar;35(3):505-11. doi: 10.1007/s00134-008-1335-x. Epub 2008 Oct 21.
PURPOSE
We sought to generate national estimates for post-cardiac arrest mortality, to assess trends, and to identify hospital factors associated with survival.
METHODS
We used a national sample of US hospitals to identify patients resuscitated after cardiac arrest from 2000 to 2004 to describe the association between hospital factors (teaching status, location, size) and mortality, length of stay, and hospital charges. Analyses were performed using logistic regression.
RESULTS
A total of 109,739 patients were identified. In-hospital mortality was 70.6%. A 2% decrease in unadjusted mortality from 71.6% in 2000 to 69.6% in 2004 (OR 0.96, P < 0.001) was observed. Mortality was lower at teaching hospitals (OR 0.58, P = 0.001), urban hospitals (OR 0.63, P = 0.004), and large hospitals (OR 0.55, P < 0.001).
CONCLUSION
Mortality after in-hospital cardiac arrest decreased over 5 years. Mortality was lower at urban, teaching, and large hospitals. There are implications for dissemination of best practices or regionalization of post-cardiac arrest care.
目的
我们试图得出全国范围内心脏骤停后死亡率的估计值，评估其趋势，并确定与生存相关的医院因素。
方法
我们使用美国医院的全国样本，确定2000年至2004年心脏骤停后复苏的患者，以描述医院因素（教学状况、位置、规模）与死亡率、住院时间和医院费用之间的关联。使用逻辑回归进行分析。
结果
共识别出109739名患者。院内死亡率为70.6%。观察到未调整的死亡率从2000年的71.6%下降2%至2004年的69.6%（比值比0.96，P<0.001）。教学医院（比值比0.58，P = 0.001）、城市医院（比值比0.63，P = 0.004）和大型医院（比值比0.55，P<0.001）的死亡率较低。
结论
院内心脏骤停后的死亡率在5年内有所下降。城市、教学和大型医院的死亡率较低。这对最佳实践的传播或心脏骤停后护理的区域化具有启示意义。
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