Abstract 350: Hospital Variation in Survival for Pediatric In-Hospital Cardiac Arrest: A Report From Get With the Guidelines -Resuscitation

Abstract

Background: Although survival after in-hospital cardiac arrest is likely to vary among hospitals caring for children, validated methods to risk-standardize pediatric survival rates across sites do not currently exist. Methods: Within the American Heart Association’s Get With the Guidelines-Resuscitation registry for in-hospital cardiac arrest, we identified 1,640 cardiac arrests in children from 168 hospitals from 2006 to 2010. Using multivariable hierarchical logistic regression, we developed and validated a model to predict survival to hospital discharge. We then applied the coefficients and random hospital intercepts from the model to examine risk-standardized rates of cardiac arrest survival for those hospitals with a minimum of 10 pediatric cardiac arrest cases. Results: A total of 15 patient-level predictors were identified: age, sex, race, cardiac arrest rhythm, location and day of arrest, mechanical ventilation, baseline depression in neurological function, major trauma, hypotension, metabolic or electrolyte abnormalities, renal insufficiency, sepsis, and use of intravenous antiarrhythmics or vasopressors at the time of arrest. The model had good discrimination (C-statistic of 0.71), confirmed by bootstrap validation (validation C-statistic of 0.69). Among 31 hospitals with at least 10 cardiac arrests, unadjusted hospital survival rates varied considerably (median, 37%; inter-quartile range [IQR]: 21% to 44%; range: 0% to 59%). After risk-standardization, variation in hospital survival rates persisted (median, 37%; IQR: 33% to 41%; range: 31% to 49%), although the range of outcomes narrowed considerably. Conclusion: In a large national registry, we developed and validated a model to predict survival after in-hospital cardiac arrest in children. Even with risk-standardization, there is significant variation in survival rates across hospitals. Leveraging these models, best practices can be assessed at high-performing hospitals and shared with others to improve care in the setting of pediatric cardiac arrest.