The factors that prolong the on-site time in pediatric trauma cases in a prehospital setting are unknown. We investigated these factors using a national trauma registry in Japan. We identified pediatric trauma patients aged ≤18 years, from January 2004 to May 2019. We categorized cases into shorter (≤13 min) and longer (>13 min) prehospital on-site time groups. We performed multivariable logistic regression analysis with multiple imputations to assess the factors associated with longer prehospital on-site time. Overall, 14,535 patients qualified for inclusion. The median prehospital on-site time was 13 min. In the multivariable logistic regression analysis, the longer prehospital on-site time was associated with higher age; suicide (Odds ratio [OR] 1.27; 95% confidence interval [CI] 1.03–1.57); violence (OR 1.74; 95%CI 1.27–2.38); higher revised trauma score, abbreviated injury scale > 3 in the spine (OR 1.25; 95%CI 1.04–1.50), upper extremity (OR 1.26; 95%CI 1.11–1.44), and lower extremity (OR 1.25; 95%CI 1.14–1.37); immobilization (OR 1.16; 95%CI 1.06–1.27); and comorbid mental retardation (OR 1.56; 95%CI 1.11–2.18). In light of these factors, time in the field could be reduced by having more pediatric emergency physicians and orthopedic surgeons available.
Background
The effectiveness of physician involvement during out-of-hospital cardiac arrest has been shown in adults but remains unknown in pediatric patients. This study aimed to investigate the association between physician involvement during pediatric out-of-hospital cardiac arrest and patient outcomes.
Methods
Using a Japanese nationwide database, we identified pediatric patients with out-of-hospital cardiac arrest from January 2005 to September 2017. We used a generalized linear model to compare outcomes between patients with and without physician involvement during pediatric out-of-hospital cardiac arrest. The primary outcome was neurologically favourable survival after 1 month. Secondary outcomes were the return of spontaneous circulation and 1-month survival.
Results
In total, 24,684 patients were included in this study. In the adjusted analyses, a ‘physician-present’ group showed a lower 1-month neurologically favourable survival rate compared with a ‘physician-absent’ group (difference, -0.9%; 95% confidence interval [CI] -1.7–-0.2; P = 0.02). The physician-present group had a higher rate of return of spontaneous circulation than the physician-absent group (difference, 1.4%; 95% CI 0.2–2.5; P = 0.02), but no difference in 1-month survival was observed between the groups (difference, -0.9%; 95% CI -2.0–0.2; P = 0.09).
Conclusions
Physician involvement during pediatric out-of-hospital cardiac arrest was associated with lower 1-month neurologically favourable survival rates, although it was associated with a better return of spontaneous circulation than that in the physician-absent group.
BackgroundThe effectiveness of physician involvement during out-of-hospital cardiac arrest has been shown in adults but remains unknown in pediatric patients. This study aimed to investigate the association between physician involvement during pediatric out-of-hospital cardiac arrest and patient outcomes.
MethodsUsing a Japanese nationwide database, we identi ed pediatric patients with out-of-hospital cardiac arrest from January 2005 to September 2017. We used a generalized linear model to compare outcomes between patients with and without physician involvement during pediatric out-of-hospital cardiac arrest.The primary outcome was neurologically favourable survival after 1 month. Secondary outcomes were the return of spontaneous circulation and 1-month survival.
ResultsIn total, 24,684 patients were included in this study. In the adjusted analyses, a 'physician-present' group showed a lower 1-month neurologically favourable survival rate compared with a 'physician-absent' group (difference, -0.9%; 95% con dence interval [CI] -1.7--0.2; P = 0.02). The physician-present group had a higher rate of return of spontaneous circulation than the physician-absent group (difference, 1.4%; 95% CI 0.2-2.5; P = 0.02), but no difference in 1-month survival was observed between the groups (difference, -0.9%; 95% CI -2.0-0.2; P = 0.09).
ConclusionsPhysician involvement during pediatric out-of-hospital cardiac arrest was associated with lower 1-month neurologically favourable survival rates, although it was associated with a better return of spontaneous circulation than that in the physician-absent group.
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