Hospital variation in survival trends for in-hospital cardiac arrest.
Bottom Line: Improvement in survival varied markedly and ranged from 3% in the bottom hospital quartile to 11% in the top hospital quartile.Compared with minor teaching hospitals (OR 1.04, 95% CI 1.02 to 1.06), hospital rate of survival improvement was greater at major teaching (OR 1.08, 95% CI 1.06 to 1.10) and nonteaching hospitals (OR 1.07, 95% CI 1.05 to 1.09, P value for interaction=0.03).Future studies are needed to identify hospital processes that have led to the largest improvement in survival.
Affiliation: University of Iowa Carver College of Medicine, Iowa City, IA (S.G.).Show MeSH
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Mentions: Within GWTG‐Resuscitation, we identified 122 746 patients at 590 hospitals during 2000–2010 who were 18 years of age or older and had an index cardiac arrest with an identifiable initial rhythm (asystole, pulseless electrical activity, ventricular fibrillation, or pulseless ventricular tachycardia) (Figure 1). From this sample, we excluded patients who were missing information on survival (n=197) and calendar year of the arrest (n=55). We also excluded 43 hospitals (5348 patients with cardiac arrest) that were missing information on hospital characteristics. Finally, given that the estimate of survival improvement from hospitals with low cardiac arrest volume or few years of available data would be unreliable, we restricted our sample to only those hospitals that participated in the registry for ≥5 years and had a mean annual case volume of ≥10 cases in accordance with previous studies.5 As a result, 313 hospitals with 23 804 patients were excluded. Our final sample consisted of 93 342 patients from 231 hospitals.
Affiliation: University of Iowa Carver College of Medicine, Iowa City, IA (S.G.).