From New York Medical College, Valhalla, NY (D.K., S.K., W.S.A., M.M., S.I., D.J., S.S., H.A.C., W.H.F., J.A.P.); Icahn School of Medicine at Mount Sinai Hospital, New York, NY (C.P.); University of Texas Southwestern Medical Center, Dallas (C.A.); VA Medical Center, Washington, DC (A.A.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and David-Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles (G.C.F.).
Circulation. 2015 Apr 21;131(16):1415-25. doi: 10.1161/CIRCULATIONAHA.114.014542. Epub 2015 Mar 19.
Regional variation in the incidence and outcomes of in-hospital cardiac arrest (IHCA) is not well studied and may have important health and policy implications.
We used the 2003 to 2011 Nationwide Inpatient Sample databases to identify patients≥18 years of age who underwent cardiopulmonary resuscitation (International Classification of Diseases, Ninth Edition, Clinical Modification procedure codes 99.60 and 99.63) for IHCA. Regional differences in IHCA incidence, survival to hospital discharge, and resource use (total hospital cost and discharge disposition among survivors) were analyzed. Of 838,465 patients with IHCA, 162,270 (19.4%) were in the Northeast, 159,581 (19.0%) were in the Midwest, 316,201 (37.7%) were in the South, and 200,413 (23.9%) were in the West. Overall IHCA incidence in the United States was 2.85 per 1000 hospital admissions. IHCA incidence was lowest in the Midwest and highest in the West (2.33 and 3.73 per 1000 hospital admissions, respectively). Compared with the Northeast, risk-adjusted survival to discharge was significantly higher in the Midwest (odds ratio, 1.33; 95% confidence interval, 1.31-1.36), South (odds ratio, 1.21; 95% confidence interval, 1.19-1.23), and West (odds ratio, 1.25; 95% confidence interval, 1.23-1.27). IHCA survival increased significantly from 2003 to 2011 in the United States and in all regions (all Ptrend<0.001). Total hospital cost was highest in the West, whereas discharge to skilled nursing facility and use of home health care among survivors was highest in the Northeast.
We observed significant regional variation in IHCA incidence, survival, and resource use in the United States. This variation was explained only partially by differences in patient and hospital characteristics. Further studies are needed to identify other potential factors responsible for these regional differences to improve outcomes after IHCA.
院内心搏骤停（IHCA）的发生率和结局存在地区差异，但这方面的研究还不够完善，其可能对健康和政策具有重要影响。
我们使用 2003 年至 2011 年全国住院患者样本数据库，确定了≥18 岁并接受心肺复苏（国际疾病分类，第 9 版临床修正程序代码 99.60 和 99.63）的 IHCA 患者。分析了 IHCA 发生率、出院存活率和资源利用（总住院费用和幸存者出院去向）的地区差异。在 838465 例 IHCA 患者中，162270 例（19.4%）来自东北部，159581 例（19.0%）来自中西部，316201 例（37.7%）来自南部，200413 例（23.9%）来自西部。美国 IHCA 的总发生率为每 1000 次住院 2.85 次。中西部的 IHCA 发生率最低（每 1000 次住院 2.33 次），西部最高（每 1000 次住院 3.73 次）。与东北部相比，中西部地区的出院调整存活率显著较高（比值比，1.33；95%置信区间，1.31-1.36），南部（比值比，1.21；95%置信区间，1.19-1.23）和西部（比值比，1.25；95%置信区间，1.23-1.27）。2003 年至 2011 年期间，美国和所有地区的 IHCA 存活率均显著增加（所有 Ptrend<0.001）。西部的总住院费用最高，而东北部的幸存者出院至熟练护理机构和使用家庭保健的比例最高。
我们观察到美国 IHCA 的发生率、存活率和资源利用存在显著的地区差异。这种差异仅部分解释了患者和医院特征的差异。需要进一步研究以确定导致这些地区差异的其他潜在因素，从而改善 IHCA 后的结局。
