Treatment and Outcome Variation in Out-of-hospital Cardiac Arrest Among Four Urban Hospitals in Detroit
Recommended Citation
Mathew S, Harrison N, Ajimal S, Silvagi R, Reece R, Klausner H, Levy P, Dunne R, and O'Neil B. Treatment and Outcome Variation in Out-of-hospital Cardiac Arrest Among Four Urban Hospitals in Detroit. Resuscitation 2023.
Document Type
Article
Publication Date
2-10-2023
Publication Title
Resuscitation
Abstract
AIMS: To determine whether out-of-hospital cardiac arrest (OHCA) post-resuscitation management and outcomes differ between four Detroit hospitals.
INTRODUCTION: Significant variation exists in treatment/outcomes from OHCA. Disparities between hospitals serving a similar population is not well known.
METHODS: Retrospective OHCA data was collected from the Detroit-Cardiac Arrest Registry (DCAR) between January 2014 to December 2019. Four hospitals were compared on two treatments (angiography, do not resuscitate (DNR)) and two outcomes (cerebral performance category (CPC) ≤ 2, in-hospital death). Models for death and CPC were tested with and without coronary angiography and DNR status.
RESULTS: 999 patients at hospitals A - D differed (p<0.05) before multivariable adjustment by age, race, witnessed arrest, dispatch-emergency department (ED) time, TTM, coronary angiography, DNR order, and in-hospital death. Rates of death and CPC ≤ 2 were worse in Hospital A (82.8%, 10%, respectively) compared to others (69.1%, 14.1%). After multivariable adjustment, Hospital A performed angiography less compared to B (OR=0.17) and was more likely to initiate new DNR status than B (OR=2.9), C (OR=16.1), or D (OR=3.6). CPC ≤ 2 were worse in Hospital A compared to B (OR=0.27) and D (OR=0.35). After sensitivity analysis, CPC ≤ 2 odds did not differ for A versus B (OR=0.58, adjusted for angiography) or D (OR=0.65, adjusted for DNR). Odds of death, despite angiography and DNR differences, were worse in Hospital A compared to B (OR=1.87) and D (OR=1.81).
CONCLUSION: Differing rates of DNR and coronary angiography was associated with observed disparities in favorable neurologic outcome, but not death, between four Detroit hospitals.
PubMed ID
36775019
ePublication
ePub ahead of print
First Page
109731
Last Page
109731
