Daytime admission is associated with higher 1-month survival for pediatric out-of-hospital cardiac arrest: Analysis of a nationwide multicenter observational study in Japan.

Mafumi Shinohara,Ichiro Takeuchi,Takeru Abe,Takashi Muguruma,Chiaki Toida,Masayasu Gakumazawa,Richard Bruce Mink

doi:10.1371/journal.pone.0246896

Mafumi Shinohara, Ichiro Takeuchi + Show 5 more

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https://doi.org/10.1371/journal.pone.0246896

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Abstract

Hospital characteristics, such as hospital type and admission time, have been reported to be associated with survival in adult out-of-hospital cardiac arrest (OHCA) patients. However, findings regarding the effects of hospital types on pediatric OHCA patients have been limited. The aim of this study was to analyze the relationship between the hospital characteristics and the outcomes of pediatric OHCA patients. This study was a retrospective secondary analysis of the Japanese Association for Acute Medicine-out-of-hospital cardiac arrest registry. The period of this study was from 1 June 2014 to 31 December 2015. We enrolled all pediatric patients (those 0-17 years of age) experiencing OHCA in this study. We enrolled all types of OHCA. The primary outcome of this study was 1-month survival after the onset of cardiac arrest. We analyzed 310 pediatric patients (those 0-17 years of age) with OHCA. In survivors, the rate of witnessed arrest and daytime admission was significantly higher than nonsurvivors (56% vs. 28%, p < 0.001: 49% vs. 31%; p = 0.03, respectively). The multiple logistic regression model showed that daytime admission was related to 1-month survival (odds ratio, OR: 95% confidence interval, CI, 3.64: 1.23-10.80) (p = 0.02). OHCA of presumed cardiac etiology and witnessed OHCA were associated with higher 1-month survival. (OR: 95% CI, 3.92: 1.23-12.47, and 6.25: 1.98-19.74, respectively). Further analyses based on the time of admission showed that there were no significant differences in the proportions of patients with witnessed arrest and who received bystander cardiopulmonary resuscitation and emergency medical service response time by admission time. Pediatric OHCA patients who were admitted during the day had a higher 1-month survival rate after cardiac arrest than patients who were admitted at night.

Highlights

The incidence of pediatric out-of-hospital cardiac arrest (OHCA) has been reported to be 8.0– 10.6 per 100,000 persons per year [1, 2]
The multiple logistic regression model showed that daytime admission was related to 1-month survival (p = 0.02)
Further analyses based on the time of admission showed that there were no significant differences in the proportions of patients with witnessed arrest and who received bystander cardiopulmonary resuscitation and emergency medical service response time by admission time

Summary

Introduction

The incidence of pediatric out-of-hospital cardiac arrest (OHCA) has been reported to be 8.0– 10.6 per 100,000 persons per year [1, 2]. A previous study utilizing a nationalbased registry reported that the proportion of children less than 18 years old among total OHCA patients was 2.4% in Japan [6]. Admitting hospital characteristics, such as critical care medical centers, teaching hospitals, annual patient numbers, and admission time, have been associated with patient outcomes in adults with OHCA [7,8,9]. Admission at night has been associated with a poor survival rate in both adult and pediatric OHCA patients, and prehospital factors and the number of staff members and the activity of medical staff might contribute to these results [14,15,16,17,18,19]. The findings of this study could contribute to build an effective admission policy for pediatric OHCA patients in hospitals

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