Duncan H P, Frew E
Paediatric Intensive Care, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom.
Resuscitation. 2009 May;80(5):529-34. doi: 10.1016/j.resuscitation.2009.02.018. Epub 2009 Mar 31.
Acute life-threatening events in children are medical emergencies requiring immediate intervention. They can be due to cardiac arrest, respiratory arrest or another cause of sudden compromise for example, choking. Internationally, hospital systems are being introduced to reduce preventable acute life-threatening events and, despite having significant resource implications, have not yet been subject to economic analysis. This study presents the additional short-term health service costs of in-hospital acute life-threatening events to inform a cost-effectiveness analysis of prevention strategies.
Patient level costs (GB pounds, price year 2005), in excess of baseline costs, were collected from a short-term NHS perspective. The cost per survivor to hospital discharge included the cost of the cardiopulmonary resuscitation attempt, resuscitation preparedness, and the cost of in-hospital post-resuscitation care. Acute life-threatening events calls were classified into two groups: cardiac arrest, and respiratory arrest and other acute life threatening events. Outcomes from these groups were compared to a similar group of unplanned Paediatric Intensive Care (PIC) admissions. All survival and length of stay outcomes were calculated for the first episode.
The survival to hospital discharge was 64.4% (65/101), (95% Confidence Intervals 55.02, 73.70) for all acute life-threatening event calls, and 41.3% (12/29), (95% Confidence Intervals 23.45, 59.31) for cardiac arrest. The mean cost of the resuscitation attempt was pound3664 for all acute life-threatening event calls, and pound3884 for cardiac arrest. The annual cost of cardiopulmonary resuscitation preparedness was pound181,565. The mean cost of the post-event length of stay in hospital was pound22,562 for cardiac arrest, pound26,335 for other acute life-threatening events, and pound26,138 for urgent PIC admissions. The cost per survivor to hospital discharge was pound53,289.
The short-term costs of paediatric in-hospital acute life-threatening events, including cardiac arrest, from an NHS perspective, are more expensive than those reported for adults, but similar to other life saving treatments. This new information will serve to improve efficiency in the current resuscitation programme and contribute to cost-effectiveness analysis of prevention strategies.
儿童急性危及生命事件属于需要立即干预的医疗紧急情况。其可能由心脏骤停、呼吸骤停或其他突发功能障碍原因引起，例如窒息。在国际上，医院系统正在引入以减少可预防的急性危及生命事件，尽管这会带来重大资源影响，但尚未进行经济分析。本研究呈现了医院内急性危及生命事件的额外短期医疗服务成本，以为预防策略的成本效益分析提供信息。
从英国国家医疗服务体系（NHS）的短期视角收集超出基线成本的患者层面成本（英镑，2005年价格）。每位存活至出院患者的成本包括心肺复苏尝试成本、复苏准备成本以及医院内复苏后护理成本。急性危及生命事件呼叫被分为两组：心脏骤停，以及呼吸骤停和其他急性危及生命事件。将这些组的结果与一组类似的非计划儿科重症监护（PIC）入院患者进行比较。计算所有首次发作的存活情况和住院时长结果。
所有急性危及生命事件呼叫的出院存活率为64.4%（65/101），（95%置信区间55.02，73.70），心脏骤停的出院存活率为41.3%（12/29），（95%置信区间23.45，59.31）。所有急性危及生命事件呼叫的复苏尝试平均成本为3664英镑，心脏骤停为3884英镑。心肺复苏准备的年度成本为181,565英镑。心脏骤停后住院时长的平均成本为22,562英镑，其他急性危及生命事件为26,335英镑，紧急PIC入院为26,138英镑。每位存活至出院患者的成本为53,289英镑。
从NHS视角来看，儿科医院内急性危及生命事件（包括心脏骤停）的短期成本比成人报告的成本更高，但与其他挽救生命的治疗相似。这一新信息将有助于提高当前复苏计划的效率，并为预防策略的成本效益分析做出贡献。
