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Pediatr Crit Care Med. 2018 Mar;19(3):186-195. doi: 10.1097/PCC.0000000000001416.

Derivation and Internal Validation of a Mortality Prediction Tool for Initial Survivors of Pediatric In-Hospital Cardiac Arrest.

Author information

1
Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
2
Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
3
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
4
Division of Cardiac Critical Care, Department of Pediatrics, Medical City Children's Hospital, Dallas, TX.
5
Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA.
6
Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
7
Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

Abstract

OBJECTIVES:

To develop a clinical prediction score for predicting mortality in children following return of spontaneous circulation after in-hospital cardiac arrest.

DESIGN:

Observational study using prospectively collected data.

SETTING:

This was an analysis using data from the Get With The Guidelines-Resuscitation registry between January 2000 and December 2015.

PATIENTS:

Pediatric patients (< 18 yr old) who achieved return of spontaneous circulation.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The primary outcome was in-hospital mortality. Patients were divided into a derivation (3/4) and validation (1/4) cohort. A prediction score was developed using a multivariable logistic regression model with backward selection. Patient and event characteristics for the derivation cohort (n = 3,893) and validation cohort (n = 1,297) were similar. Seventeen variables associated with the outcome remained in the final reduced model after backward elimination. Predictors of in-hospital mortality included age, illness category, pre-event characteristics, arrest location, day of the week, nonshockable pulseless rhythm, duration of chest compressions, and interventions in place at time of arrest. The C-statistic for the final score was 0.77 (95% CI, 0.75-0.78) in the derivation cohort and 0.77 (95% CI, 0.74-0.79) in the validation cohort. The expected versus observed mortality plot indicated good calibration in both the derivation and validation cohorts. The score showed a stepwise increase in mortality with an observed mortality of less than 15% for scores 0-9 and greater than 80% for scores greater than or equal to 25. The model also performed well for neurologic outcome and in sensitivity analyses for events within the past 5 years and for patients with or without a pulse at the onset of chest compressions.

CONCLUSIONS:

We developed and internally validated a prediction score for initial survivors of pediatric in-hospital cardiac arrest. This prediction score may be useful for prognostication following cardiac arrest, stratifying patients for research, and guiding quality improvement initiatives.

PMID:
29239980
PMCID:
PMC5834369
[Available on 2019-03-01]
DOI:
10.1097/PCC.0000000000001416

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