title: Prevalence and outcomes of pediatric in-hospital cardiopulmonary resuscitation in the United States: an analysis of the Kids' Inpatient Database*.
abstract: OBJECTIVE
  Population-based data on pediatric in-hospital cardiopulmonary resuscitation in the United States are scarce. Single-center studies and voluntary registries may skew the estimated prevalence and outcomes. This study aimed to determine the prevalence and outcomes of pediatric cardiopulmonary resuscitation on a national scale.
  
  
  METHODS
  A retrospective analysis of the Healthcare Cost and Utilization Project 2006 Kids' Inpatient Database was performed. Sample weighting was employed to produce national estimates.
  
  
  METHODS
  Three thousand seven hundred thirty-nine hospitals in 38 states participating with the Kids' Inpatient Database.
  
  
  METHODS
  All patients <20 yrs of age hospitalized in participating institutions in 2006.
  
  
  RESULTS
  Cardiopulmonary resuscitation was performed in 5,807 (95% confidence interval 5259-6355) children with prevalence of 0.77 per 1,000 admissions. Most patients (68%) were <1 yr old, and 44% were female. On multivariable analysis, cardiopulmonary resuscitation was associated with respiratory failure (odds ratio 41.5, 95% confidence interval 35.4-48.8), myocarditis (odds ratio 36.6, 95% confidence interval 21.9-61.0), acute renal failure (odds ratio 21.6, 95% confidence interval 17.5-26.7), heart failure (odds ratio 3.8, 95% confidence interval 3.0-4.8), and cardiomyopathy (odds ratio 3.8, 95% confidence interval 3.2-4.7). Overall mortality was 51.8% and greater among patients ≥1 yr (68%) vs. <1 yr (44%) (odds ratio 2.7, 95% confidence interval 2.3-3.2). Factors associated with mortality among patients receiving cardiopulmonary resuscitation on multivariable analysis included acute renal failure (odds ratio 1.5, 95% confidence interval 1.1-1.9), hepatic insufficiency (odds ratio 1.5, 95% confidence interval 1.01-2.4), sepsis (odds ratio 1.2, 95% confidence interval 1.01-1.4), and congenital heart disease (odds ratio 1.2, 95% confidence interval 1.01-1.5).
  
  
  CONCLUSIONS
  Cardiopulmonary resuscitation is performed in approximately one in 1,300 pediatric hospitalizations. Approximately half of patients receiving cardiopulmonary resuscitation do not survive to discharge. Independent risk factors for mortality after receiving cardiopulmonary resuscitation included congenital heart disease, age ≥1 yr, acute renal failure, hepatic insufficiency, and sepsis.
authors.affiliation: Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA. knudson@bcm.edu
authors.forename: Jarrod D
authors.initials: JD
authors.lastname: Knudson
authors.forename: Steven R
authors.initials: SR
authors.lastname: Neish
authors.forename: Antonio G
authors.initials: AG
authors.lastname: Cabrera
authors.forename: Adam W
authors.initials: AW
authors.lastname: Lowry
authors.forename: Pirouz
authors.initials: P
authors.lastname: Shamszad
authors.forename: David L S
authors.initials: DL
authors.lastname: Morales
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Graves
authors.forename: Eric A
authors.initials: EA
authors.lastname: Williams
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Rossano
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult