Abstract 91: Weekend Admission Following Non-Traumatic Out-of-Hospital Cardiac Arrest is a Prognosticator of Poor Outcome: Results from a Nationwide Database

Abstract

Background: In the United States, differences in outcome based on day of admission have been reported for several disease entities including in-hospital cardiac arrest. We investigated whether outcomes are similarly affected in patients with non-traumatic out-of-hospital cardiac arrest (OHCA). Methods: The 2010 Nationwide Inpatient Sample and Nationwide Emergency Department Sample are nationally representative databases containing data on 8 and 21 million discharges, respectively. We included all patients with an ICD-9 CM code for a principle diagnosis of cardiac arrest and excluded those with ICD-9 CM code for any diagnosis of trauma. We defined “weekend” as Saturday 12:01 am to Sunday 11:59 pm. The primary outcome was a composite endpoint of in-hospital death or discharge to hospice. Secondary outcomes are listed in the table. Poor neurologic outcome was a composite endpoint of coma, vegetative state or anoxic brain injury with feeding tube or tracheostomy placement in patients discharged alive. Adjusted odds ratios were calculated using multivariable regression analyses. Results: In 2010, 140,128 OHCA patients were admitted to an ED in the United States; 29.3% occurred on the weekend. Ventricular fibrillation was the presenting rhythm in 3.8% of emergency department OHCA visits. Overall survival to hospital admission and discharge were only 8.2% and 4.8% respectively. When adjusted for variables known to affect outcome (Table), total in-hospital mortality remained higher on weekends compared with weekdays. Other outcomes, including the use of hypothermia were similar between weekends and weekdays. Conclusion: Despite the many advances in resuscitation systems, the national survival to hospital admission and discharge for non-traumatic out-of-hospital cardiac arrest remains very low. Yet again, a weekend admission appears as an independent predictor of higher in-hospital mortality in this patient population.