Current Utilization of Interosseous Access in Pediatrics: A Population-Based Analysis using an EHR database, TriNetX

Abstract

Background: Interosseous (IO) usage in the pediatric population has been mostly studied in the setting of cardiac arrest. Population-based studies identifying the indications and complications associated with age, however, are sparse. Results: This was a retrospective observational cohort study utilizing the TriNetX ® electronic health record data. Thirty-seven hospitals were included in the data set with 1012 patients where an IO procedure code was reported in the emergency department or inpatient setting. The cohort was split into two groups, pediatric subjects < 1 year of age and those ≥ 1 year of age. A total incidence of IO line placement of 18 per 100,000 pediatric encounters was reported. Total mortality was 31.8%, with a higher rate of mortality seen in subjects < 1 year of age (39.2% vs 29.0%; p = 0.0028). A diagnosis of cardiac arrest was more frequent in subjects < 1 year of age (51.5% vs 38.0%; p = 0.002), and a diagnosis of convulsions was more frequent in those ≥ 1 of age (28.0% vs 13.8%; p <0.01). Overall, 29 (2.9%) subjects had at least one complication. Conclusions: More IOs were placed in subjects ≥ 1 year of age, and a higher rate of mortality was seen in subjects < 1 year of age. Lower frequencies of non-cardiac diagnoses at the time of IO placement were found in both groups, highlighting IO may be underutilized in non-cardiac settings such as convulsions, shock, and respiratory failure. Given the low rate of complications seen in both groups of our study, IO use should be considered early on for urgent vascular access, especially for children less than 1 year of age.