Gupta Punkaj, Tang Xinyu, Gall Christine M, Lauer Casey, Rice Tom B, Wetzel Randall C
Division of Pediatric Critical Care, Department of Pediatrics, University of Arkansas Medical Center, Little Rock, AR, United States; Division of Pediatric Cardiology, Department of Pediatrics, University of Arkansas Medical Center, Little Rock, AR, United States.
Division of Biostatistics, Department of Pediatrics, University of Arkansas Medical Center, Little Rock, AR, United States.
Resuscitation. 2014 Nov;85(11):1473-9. doi: 10.1016/j.resuscitation.2014.07.016. Epub 2014 Aug 7.
To describe epidemiology and outcomes associated with cardiac arrest among critically ill children across hospitals of varying center volumes.
Patients <18 years of age in the Virtual PICU Systems (VPS, LLC) Database (2009-2013) were included. Patients with both cardiac and non-cardiac diagnoses were included. Data on demographics, patient diagnosis, cardiac arrest, severity of illness and outcomes were collected. Hierarchical cluster analysis was performed to categorize all the participating centers into low, low-medium, high-medium, and high volume groups using the center volume characteristics (annual hospital discharges per center, annual extracorporeal membrane oxygenation per center, and annual mechanical ventilators per center). Multivariable models were used to evaluate association of center volume with incidence of cardiac arrest, and mortality after cardiac arrest, adjusting for patient and center characteristics.
Of 329,982 patients (108 centers), 2.2% (n=7390) patients had cardiac arrest with an associated mortality of 35% (n=2586). In multivariable models controlling for patient and center characteristics, center volume was not associated with either the incidence of cardiac arrest (OR: 1.00; 95% CI: 0.95-1.06; p=0.98), or mortality in those with cardiac arrest (OR: 0.93; 95% CI: 0.82-1.06; p=0.27). These associations were similar across cardiac and non-cardiac disease categories. Furthermore, we demonstrated that there was no correlation between incidence of cardiac arrest and mortality in those with cardiac arrest across different study hospitals in adjusted models.
Both incidence of cardiac arrest, and mortality in those with cardiac arrest vary substantially across hospitals. However, center volume is not associated with either of these outcomes, after adjusting for patient and center characteristics.
描述不同中心规模医院中危重症儿童心脏骤停的流行病学特征及相关结局。
纳入虚拟儿科重症监护系统（VPS，有限责任公司）数据库（2009 - 2013年）中年龄＜18岁的患者。纳入同时患有心脏和非心脏疾病诊断的患者。收集人口统计学、患者诊断、心脏骤停、疾病严重程度及结局的数据。采用分层聚类分析，根据中心规模特征（每个中心的年出院人数、每个中心的年体外膜肺氧合使用量和每个中心的年机械通气机使用量）将所有参与研究的中心分为低、低 - 中、高 - 中、高规模组。使用多变量模型评估中心规模与心脏骤停发生率以及心脏骤停后死亡率之间的关联，并对患者和中心特征进行校正。
在329,982例患者（108个中心）中，2.2%（n = 7390）的患者发生心脏骤停，相关死亡率为35%（n = 2586）。在控制患者和中心特征的多变量模型中，中心规模与心脏骤停发生率（比值比：1.00；95%置信区间：0.95 - 1.06；p = 0.98）或心脏骤停患者的死亡率（比值比：0.93；95%置信区间：0.82 - 1.06；p = 0.27）均无关联。这些关联在心脏和非心脏疾病类别中相似。此外，我们证实在校正模型中，不同研究医院心脏骤停的发生率与心脏骤停患者的死亡率之间无相关性。
不同医院之间心脏骤停的发生率以及心脏骤停患者的死亡率差异很大。然而，在对患者和中心特征进行校正后，中心规模与这些结局均无关联。
