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【文摘发布】JAMA——住院病人夜晚及周末心脏骤
Survival From In-Hospital Cardiac Arrest During Nights and Weekends
Mary Ann Peberdy, MD; Joseph P. Ornato, MD; G. Luke Larkin, MD, MSPH, MS; R. Scott Braithwaite, MD; T. Michael Kashner, PhD, JD; Scott M. Carey; Peter A. Meaney, MD, MPH; Liyi Cen, MS; Vinay M. Nadkarni, MD, MS; Amy H. Praestgaard, MS; Robert A. Berg, MD; for the National Registry of Cardiopulmonary Resuscitation Investigators
JAMA. 2008;299(7):785-792.
Context Occurrence of in-hospital cardiac arrest and survival patterns have not been characterized by time of day or day of week. Patient physiology and process of care for in-hospital cardiac arrest may be different at night and on weekends because of hospital factors unrelated to patient, event, or location variables.
Objective To determine whether outcomes after in-hospital cardiac arrest differ during nights and weekends compared with days/evenings and weekdays.
Design and Setting We examined survival from cardiac arrest in hourly time segments, defining day/evening as 7:00 AM to 10:59 PM, night as 11:00 PM to 6:59 AM, and weekend as 11:00 PM on Friday to 6:59 AM on Monday, in 86 748 adult, consecutive in-hospital cardiac arrest events in the National Registry of Cardiopulmonary Resuscitation obtained from 507 medical/surgical participating hospitals from January 1, 2000, through February 1, 2007.
Main Outcome Measures The primary outcome of survival to discharge and secondary outcomes of survival of the event, 24-hour survival, and favorable neurological outcome were compared using odds ratios and multivariable logistic regression analysis. Point estimates of survival outcomes are reported as percentages with 95% confidence intervals (95% CIs).
Results A total of 58 593 cases of in-hospital cardiac arrest occurred during day/evening hours (including 43 483 on weekdays and 15 110 on weekends), and 28 155 cases occurred during night hours (including 20 365 on weekdays and 7790 on weekends). Rates of survival to discharge (14.7% [95% CI, 14.3%-15.1%] vs 19.8% [95% CI, 19.5%-20.1%], return of spontaneous circulation for longer than 20 minutes (44.7% [95% CI, 44.1%-45.3%] vs 51.1% [95% CI, 50.7%-51.5%]), survival at 24 hours (28.9% [95% CI, 28.4%-29.4%] vs 35.4% [95% CI, 35.0%-35.8%]), and favorable neurological outcomes (11.0% [95% CI, 10.6%-11.4%] vs 15.2% [95% CI, 14.9%-15.5%]) were substantially lower during the night compared with day/evening (all P values < .001). The first documented rhythm at night was more frequently asystole (39.6% [95% CI, 39.0%-40.2%] vs 33.5% [95% CI, 33.2%-33.9%], P < .001) and less frequently ventricular fibrillation (19.8% [95% CI, 19.3%-20.2%] vs 22.9% [95% CI, 22.6%-23.2%], P < .001). Among in-hospital cardiac arrests occurring during day/evening hours, survival was higher on weekdays (20.6% [95% CI, 20.3%-21%]) than on weekends (17.4% [95% CI, 16.8%-18%]; odds ratio, 1.15 [95% CI, 1.09-1.22]), whereas among in-hospital cardiac arrests occurring during night hours, survival to discharge was similar on weekdays (14.6% [95% CI, 14.1%-15.2%]) and on weekends (14.8% [95% CI, 14.1%-15.2%]; odds ratio, 1.02 [95% CI, 0.94-1.11]).
Conclusion Survival rates from in-hospital cardiac arrest are lower during nights and weekends, even when adjusted for potentially confounding patient, event, and hospital characteristics.
Author Affiliations: Virginia Commonwealth University, Richmond (Drs Peberdy and Ornato); Yale School of Medicine, New Haven, Connecticut (Drs Larkin and Braithwaite); University of Texas Southwestern Medical Center, Dallas (Dr Kashner); Digital Innovation, Forest Hill, Maryland (Mr Carey); School of Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania (Drs Meaney and Nadkarni); Biostatistics Analysis Center, University of Pennsylvania, Philadelphia (Mss Cen and Praestgaard); and College of Medicine, University of Arizona, Tucson (Dr Berg) 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 Survival From In-Hospital Cardiac Arrest During Nights and Weekends
住院病人夜间和周末发生心脏骤停的生存
Context Occurrence of in-hospital cardiac arrest and survival patterns have not been characterized by time of day or day of week. Patient physiology and process of care for in-hospital cardiac arrest may be different at night and on weekends because of hospital factors unrelated to patient, event, or location variables.
背景：对于住院病人心脏骤停的发生和生存方式还没有进行一天内的时间区分和一周内不同天的区分。由于与病人、事件和地点变量无关的医院因素，住院病人在夜间和周末的生理状态和治疗过程可能不同。
Objective To determine whether outcomes after in-hospital cardiac arrest differ during nights and weekends compared with days/evenings and weekdays.
目的：本研究试图探讨住院病人夜间和周末发生心脏骤停与白天/晚上和工作日发生心脏骤停相比是否有不同的预后。
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作者:admin@医学,生命科学 2011-03-09 13:23
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