Survival Rates Following Pediatric In-Hospital Cardiac Arrests During Nights and Weekends.
Survival Rates Following Pediatric In-Hospital Cardiac Arrests During Nights and Weekends.
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DOI：
10.1001/jamapediatrics.2016.2535
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发表时间：
2017-01-01
期刊：
影响因子：
26.1
通讯作者：
American Heart Association’s Get With the Guidelines–Resuscitation Investigators
中科院分区：
文献类型：
--
作者：
Bhanji F;Topjian AA;Nadkarni VM;Praestgaard AH;Hunt EA;Cheng A;Meaney PA;Berg RA;American Heart Association’s Get With the Guidelines–Resuscitation Investigators
美国每年有近6000名住院儿童接受心肺复苏术（CPR）。关于这些儿童的生存是否受到事件发生时间（例如，夜间或周末）的影响，我们知之甚少。生存率的差异可能对医院的人员配备、培训和资源分配产生重要影响。确定夜间和周末与白天/晚上和工作日相比，儿科住院心脏骤停后的结局是否不同。这项研究包括了从2000年1月1日到2012年12月12日参加美国心脏协会指南复苏登记的354家医院。纳入了所有18岁以下接受CPR至少2分钟的儿童的索引病例（12404名儿童）。数据分析于2014年12月和2016年6月进行。我们使用之前定义的白天/傍晚和夜晚以及周末的时间间隔，聚合了每小时的时间块。多变量logistic回归模型被用来检查独立变量对出院生存率的影响。我们使用了基于既往文献的先验变量组合（包括年龄、首次记录的心律、事件在医院的位置、体外CPR和作为停搏原因的低血压），以及在双变量广义估计方程模型中识别的变量，并在最终多变量模型中保持P ≤ .15的显著性。主要结局指标是出院时的生存率，次要结局包括持续20分钟以上的循环恢复和24小时生存率。在12404名儿童（56.0%为男性）中，8731名（70.4%）经历了持续超过20分钟的循环恢复，7248名（58.4%）存活24小时，4488名（36.2%）存活至出院。在调整潜在混杂因素后，我们发现夜间患者的出院存活率低于白天/夜间患者（调整后比值比为0.88 [95%CI，0.80-0.97]; P = 0.007），但周末和工作日之间无差异（调整后比值比为0.92 [95%CI，0.84-1.01]; P = 0.09）。即使在调整了许多潜在的混杂患者、事件和医院相关因素后，夜间发生的小儿CPR事件的出院存活率也低于白天和夜间发生的CPR事件。
Nearly 6000 hospitalized children in the United States receive cardiopulmonary resuscitation (CPR) annually. Little is known about whether the survival of these children is influenced by the time of the event (eg, nighttime or weekends). Differences in survival could have important implications for hospital staffing, training, and resource allocation. To determine whether outcomes after pediatric in-hospital cardiac arrests differ during nights and weekends compared with days/evenings and weekdays. This study included a total of 354 hospitals participating in the American Heart Association’s Get With the Guidelines–Resuscitation registry from January 1, 2000, to December 12, 2012. Index cases (12 404 children) from all children younger than 18 years of age receiving CPR for at least 2 minutes were included. Data analysis was performed in December 2014 and June 2016. We aggregated hourly blocks of time, using previously defined time intervals of day/evening and night, as well as weekend. Multivariable logistic regression models were used to examine the effect of independent variables on survival to hospital discharge. We used a combination of a priori variables based on previous literature (including age, first documented rhythm, location of event in hospital, extracorporeal CPR, and hypotension as the cause of arrest), as well as variables that were identified in bivariate generalized estimating equation models, and maintained significance of P ≤ .15 in the final multivariable models. The primary outcome measure was survival to hospital discharge, and secondary outcomes included return of circulation lasting more than 20 minutes and 24-hour survival. Of 12 404 children (56.0% were male), 8731 (70.4%) experienced a return of circulation lasting more than 20 minutes, 7248 (58.4%) survived for 24 hours, and 4488 (36.2%) survived to hospital discharge. After adjusting for potential confounders, we found that the rate of survival to hospital discharge was lower during nights than during days/evenings (adjusted odds ratio, 0.88 [95% CI, 0.80–0.97]; P = .007) but was not different between weekends and weekdays (adjusted odds ratio, 0.92 [95% CI, 0.84–1.01]; P = .09). The rate of survival to hospital discharge was lower for pediatric CPR events occurring at night than for CPR events occurring during daytime and evening hours, even after adjusting for many potentially confounding patient-, event-, and hospital-related factors.
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影响因子：
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作者：
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通讯作者：
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