259 - A Numbers Game - Comparing Definitions of Pediatric Out-Of-Hospital Cardiac Arrest using a National EMS Database

Publication Number: 259.3686

Courtney A.. Kelly, Children's Hospital of Michigan, Ferndale, MI, United States; Sriram Ramgopal, Ann & Robert H. Lurie Children's Hospital of Chicago, Oak Park, IL, United States; Rasha Kazi, Children's Hospital of Michigan, Royal Oak, MI, United States; Nirupama Kannikeswaran, Central Michigan University College of Medicine, Detroit, MI, United States; Lindsay R. Jaeger, Children’s Healthcare of Atlanta, Atlanta, GA, United States

Background: Pediatric out-of-hospital cardiac arrest (POHCA) is an uncommon but critical event, with only 6% of children surviving to hospital discharge. Robust research using large datasets is required to improve patient outcomes, but inconsistent reporting practices and the lack of standardized case definitions constrain efforts.

Objective: To evaluate the documentation of POHCA and compare definitions used to identify POHCA events in the National Emergency Medical Services Information System (NEMSIS), the largest database of Emergency Medical Services (EMS) activations in the United States.

Design/Methods: We performed a retrospective review of the 2018-2023 NEMSIS datasets and explored POHCA events using varying case definitions. We included EMS activations for POHCA in children aged 1 day to 18 years based on three case-selection criteria: 1. EMS documentation of cardiac arrest, 2. Care reports with impression/symptoms of cardiac arrest, and 3. Performance of cardiopulmonary resuscitation (CPR). We compared demographics (age, sex), event (location, urbanicity, US census region, witnessed arrest, bystander CPR, presumed cause, initial cardiac rhythm), and run characteristics (scene time, transport time), intervention, and return of spontaneous circulation under each definition.

Results: Of 10,049,058 pediatric scene encounters over the 5-year study period, 61,255 (0.6%) met at least one case definition for POHCA. Among all cases, there was substantial agreement between differing criteria for POHCA (Fleiss’ Kappa=0.79). The largest group was identified using EMS documentation (55,023 cases), followed by impression/symptoms (40,956 cases), and CPR (39,737 cases). There was only a 53% overlap in POHCA identification between all three selection criteria. While cases selected by CPR procedure and impression/symptoms criteria were largely accounted for by EMS documentation of cardiac arrest, 10% of encounters fell outside of EMS criteria (Figure 1). There was no difference in patient demographics, event and run characteristics, and etiology of cardiac arrests among the three definitions (Table 1). The proportion of prehospital ROSC was low, with a ROSC rate of 4% across all definitions.

Conclusion(s): We describe three ways of documenting POHCA in a national EMS database. While overall agreement in case selection was substantial, only half of the encounters met all three criteria, suggesting a broader approach toward identifying pediatric cardiac arrest is most appropriate. Further investigation with standardized case definitions is needed to accurately characterize out-of-hospital cardiac arrest epidemiology in children.

Figure 1
Overlap In The Identification Of Pediatric Out-Of-Hospital Cardiac Arrest Encounters Between Selection Criteria

Table 1
Definitions Table PAS.xlsx - Characteristics (1).pdfCharacteristics of Pediatric Out-Of-Hospital Cardiac Arrest Encounters By Selection Criteria

Table 2
Interventions Table PAS.xlsx - Characteristics (1).pdfInterventions Performed In Pediatric Out-Of-Hospital Cardiac Arrest Encounters By Selection Criteria