Abstract 150: Left-digit Bias In Out-hospital Cardiac Arrest - JCS ReSS

Abstract

Introduction: Left-digit bias, a cognitive bias, has been linked to medical errors in clinical decision-making. Although the impact of left-digit bias on outcome and behavior has previously been examined in the setting of in-hospital cardiac arrest, that in the setting of our-of-hospital cardiac arrest has not been fully evaluated. In the current study, we investigated the impact of left-digit bias on resuscitators’ behavior during out-of-hospital cardiac arrest (OHCA). Methods: The All-Japan Utstein Registry of the Fire and Disaster Management Agency is a nationwide, prospective, population-based OHCA registration system in the Utstein format. We retrospectively included all consecutive OHCA patients within three years below and above the age of 80 witnessed by family members from January 1, 2005, to December 31, 2020. The primary endpoints were the percentage of bystander-initiated cardiopulmonary resuscitation (BCPR) performed by family members or EMS and the percentage of prehospital physician-staffed advanced cardiac life support (ACLS). We compared the percentages of resuscitation performed by family members, emergency medical services (EMS), and physicians, by using a regression discontinuity methodology to evaluate if there was a dramatic change in the percentage of BCPR and ACLS performed rate at the age threshold of 80 years, which would imply left-digit bias. Results: Of total 1,930,273 cases of OHCA in the All-Japan Utstein registry, we enrolled total of 92,674 (4.8%) patients. The mean age of the population was 80.1 years; 61284 (66.1%) patients were men. There were 37,903 (40.9%) patients between the ages of 77 and 80, and 54,771 (59.1%) patients between the ages of 80 and 83. In this model, we identified no discontinuities in the level (risk difference, -0.50%; 95%CI -1.35% to 0.36%, 0.27%; 95%CI -0.29% to 0.84%, 0.68%; 95%CI -0.29% to 1.66%) for the percentage of BCPR by family members and EMS, and physicians’ ACLS, respectively. Conclusions: In conclusion, our findings did not imply that age-related cognitive bias affected the resuscitators’ behavior during out-of-hospital cardiac arrest.