NEW YORK (Reuters Health) – Survival rates after pediatric in-hospital cardiac arrests are lower at night and on the weekend than during day/evening hours and on weekdays, researchers report.
“Ten percent more lives are saved when the pediatric cardiac arrest happens during the day or evening compared to when cardiac arrest occurs at night, even when accounting for many important patient risk factors,” Dr. Farhan Bhanji from McGill University, Montreal, Quebec, Canada told Reuters Health. Recent studies have shown worse outcomes for adults after cardiac arrest in hospital at night rather than during the day, but similar in-hospital studies of children are lacking.
Dr. Bhanji and colleagues used data from the American Heart Association’s Get With the Guidelines-Resuscitation registry to evaluate survival rates for children who had an in-hospital cardiac arrest in the day/evening (7 AM to 10:59 PM) versus night (11 PM to 6:59 AM) and on weekdays (from 7 AM on Monday until 10:59 PM on Friday) versus weekends (from 11 PM on Friday to 6:59 AM on Monday).
After adjustment for various confounders, the rate of survival to hospital discharge was 12% lower at night than during the day/evening (P = 0.007), according to a recent JAMA Pediatrics online report.
Survival to hospital discharge was 8% lower on weekends than on weekdays, but this difference fell short of statistical significance (P = 0.09). Adjusted rates of 24-hour survival were 20% lower at night than during the day/evening and 13% lower during weekends than during weekdays.
The rate of survival to hospital discharge was also 15% lower during the night than during the day (9 AM to 4 PM), but rates of survival to hospital discharge did not differ significantly between weekend days and weekday days or between weekend nights and weekday nights.
“If hospitals could improve their processes of care so that survival rates were as good throughout the week as they are during the weekday daytimes, we estimate that 300 more children would survive after in-hospital cardiac arrest every year in the United States – that’s more than 5 children every week (on average),” Dr. Bhanji said by email.
“Although our study does not identify the specific mechanisms that will eliminate the disparity between the night vs day/evening survival, it may have important implications for hospital staffing, training, and resource allocation,” Dr. Bhanji added. “Further research might explore the effect of hospital staffing, better patient monitoring with early detection of decompensation, the presence of a rapid response team, and the quality of CPR on the differential survival between day/evenings and nights.”