title: Unchanged pediatric out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America.
abstract: Outcomes for pediatric out-of-hospital cardiac arrest (OHCA) are poor. Our objective was to determine temporal trends in incidence and mortality for pediatric OHCA.
  
  
  
  Adjusted incidence and hospital mortality rates of pediatric non-traumatic OHCA patients from 2007-2012 were analyzed using the 9 region Resuscitation Outcomes Consortium-Epidemiological Registry (ROC-Epistry) database. Children were divided into 4 age groups: perinatal (<3 days), infants (3days-1year), children (1-11 years), and adolescents (12-19 years). ROC regions were analyzed post-hoc.
  
  
  
  We studied 1738 children with OHCA. The age- and sex-adjusted incidence rate of OHCA was 8.3 per 100,000 person-years (75.3 for infants vs. 3.7 for children and 6.3 for adolescents, per 100,000 person-years, p<0.001). Incidence rates differed by year (p<0.001) without overall linear trend. Annual survival rates ranged from 6.7-10.2%. Survival was highest in the perinatal (25%) and adolescent (17.3%) groups. Stratified by age group, survival rates over time were unchanged (all p>0.05) but there was a non-significant linear trend (1.3% increase) in infants. In the multivariable logistic regression analysis, infants, unwitnessed event, initial rhythm of asystole, and region were associated with worse survival, all p<0.001. Survival by region ranged from 2.6-14.7%. Regions with the highest survival had more cases of EMS-witnessed OHCA, bystander CPR, and increased EMS-defibrillation (all p<0.05).
  
  
  
  Overall incidence and survival of children with OHCA in ROC regions did not significantly change over a recent 5year period. Regional variation represents an opportunity for further study to improve outcomes.
authors: Division of Pediatric Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Faculty Pavilion, 2nd Floor, Pittsburgh, PA 15224, USA. Electronic address: finkel@ccm.upmc.edu.
authors: Ericka L
authors: EL
authors: Fink
authors: Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, USA.
authors: David K
authors: DK
authors: Prince
authors: Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
authors: Jonathan R
authors: JR
authors: Kaltman
authors: Stead Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
authors: Dianne L
authors: DL
authors: Atkins
authors: Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
authors: Michael
authors: M
authors: Austin
authors: Oregon Health & Science University Doernbecher Children's Hospital, Portland, OR, USA.
authors: Craig
authors: C
authors: Warden
authors: Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: Jamie
authors: J
authors: Hutchison
authors: Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA.
authors: Mohamud
authors: M
authors: Daya
authors: Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: Scott
authors: S
authors: Goldberg
authors: Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, USA.
authors: Heather
authors: H
authors: Herren
authors: Division of Pediatric Critical Care Medicine, Department of Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
authors: Janice A
authors: JA
authors: Tijssen
authors: Department of Emergency Medicine, University of British Columbia, Vancouver, Canada.
authors: James
authors: J
authors: Christenson
authors: Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.
authors: Christian
authors: C
authors: Vaillancourt
authors: Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: Ronna
authors: R
authors: Miller
authors: Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, USA.
authors: Robert H
authors: RH
authors: Schmicker
authors: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors: Clifton W
authors: CW
authors: Callaway
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009656:North America / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy; D012042:Registries; D016019:Survival Analysis
keywords: Cardiac arrest; Epidemiology; Outcomes; Pediatric; Resuscitation