title: Survival following witnessed pediatric out-of-hospital cardiac arrests during nights and weekends.
abstract: BACKGROUND
  The relationship between survival rate following pediatric out-of-hospital cardiac arrests (OHCAs) and time of day or day of week is unknown.
  
  
  METHODS
  A nationwide, prospective, population-based observational investigation of consecutive witnessed pediatric OHCAs (<18 years) with resuscitation attempts was conducted from January 2005 to December 2011. Days were defined as 9:00 am to 4:59 pm, nights as 5:00 pm to 8:59 am, weekdays as Mondays to Fridays, and weekends as Saturdays, Sundays, and national holidays. Primary outcome was one-month survival and secondary outcome was survival with favorable neurologic outcome, defined as cerebral performance category 1 or 2.
  
  
  RESULTS
  A total of 3278 bystander-witnessed pediatric OHCAs were registered. One month survival rate was significantly lower during nights than days (15.5% [95% CI: 13.8-17.2%] versus 23.3% [95% CI: 21.1-25.6%]; P<0.001 and during weekends/holidays (15.7% [95% CI: 13.6-18.0%] than weekdays (20.4% [95% CI: 18.7-22.2%]; P=0.001. Survival rate with favorable neurologic outcome was substantially lower during nights 7.5% [95% CI: 6.3-8.8%] than days (12.2% [95% CI: 10.6-14.1%]; P<0.001), and during weekends/holidays (7.7% [95% CI: 6.2-9.5%] than weekdays (10.4% [95% CI: 9.2-11.8%]; P=0.012). After adjusting for potential confounding factors, one-month survival rate remained significantly lower during nights compared to days (odds ratio 0.68; 95% CI: 0.56-0.82), and during weekends/holidays compared to weekdays (odds ratio 0.79; 95% CI, 0.65-0.97).
  
  
  CONCLUSIONS
  One-month survival rate following bystander-witnessed pediatric OHCAs was lower during nights and weekends/holidays than days and weekdays, even when adjusted for potentially confounding factors.
authors.affiliation: Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Ymamada-oka, Suita 565-0871, Osaka, Japan. Electronic address: lucky_unatan@yahoo.co.jp.
authors.forename: Tetsuhisa
authors.initials: T
authors.lastname: Kitamura
authors.affiliation: Division Department of Public Health, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku 162-8666, Tokyo, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Kiyohara
authors.affiliation: Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City 569-8686, Osaka, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Nitta
authors.affiliation: Department of Anesthesia and Critical Care Medicine and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.affiliation: Department of Anesthesia and Critical Care Medicine and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.affiliation: Kyoto University Health Services, Yoshida-Honmachi, Sakyo-ku 606-8501, Kyoto, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Iwami
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005104:Expert Testimony; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy; D011159:Population Surveillance / Q000379:methods*; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Cardiac arrest; Cardiopulmonary resuscitation; Epidemiology; Pediatrics