title: Hospital variation in survival after pediatric in-hospital cardiac arrest.
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.
  
  
  RESULTS
  From 2006 to 2010, within the American Heart Association's Get With the Guidelines-Resuscitation registry for in-hospital cardiac arrest, we identified 1551 cardiac arrests in children (<18 years). Using multivariable hierarchical logistic regression, we developed and validated a model to predict survival to hospital discharge and calculated risk-standardized rates of cardiac arrest survival for hospitals with a minimum of 10 pediatric cardiac arrest cases. A total of 13 patient-level predictors were identified: age, sex, cardiac arrest rhythm, location of arrest, mechanical ventilation, acute nonstroke neurological event, major trauma, hypotension, metabolic or electrolyte abnormalities, renal insufficiency, sepsis, illness category, and need for intravenous vasoactive agents prior to the arrest. The model had good discrimination (C-statistic of 0.71), confirmed by bootstrap validation (validation C-statistic of 0.69). Among 30 hospitals with ≥10 cardiac arrests, unadjusted hospital survival rates varied considerably (median, 37%; interquartile range, 24-42%; range, 0-61%). After risk-standardization, the range of hospital survival rates narrowed (median, 37%; interquartile range, 33-38%; range, 29-48%), but variation in survival persisted.
  
  
  CONCLUSIONS
  Using a national registry, we developed and validated a model to predict survival after in-hospital cardiac arrest in children. After risk-standardization, significant variation in survival rates across hospitals remained. Leveraging these models, future studies can identify best practices at high-performing hospitals to improve survival outcomes for pediatric cardiac arrest. (
authors.forename: Natalie
authors.initials: N
authors.lastname: Jayaram
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Vinay
authors.initials: V
authors.lastname: Nadkarni
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.forename: Fengming
authors.initials: F
authors.lastname: Tang
authors.forename: Tia
authors.initials: T
authors.lastname: Raymond
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Guerguerian
authors.forename: Paul S
authors.initials: PS
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010351:Patient Discharge / Q000639:trends; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology