Healthcare Utilization Following Pediatric Out-of-Hospital Cardiac Arrest

Abstract

Background: Understanding longterm health care utilization after survival of a pediatric OHCA (out-of-hospital cardiac arrest) may allow more fully integrated and cost-conscious health care. Objective: To evaluate frequency and type of re-hospitalizations, procedures and hospital charges for pediatric OHCA survivors. Methods: Retrospective cohort study from 1/1/1976 to 12/31/2007 of persons < 19 years who survived OHCA in King County, WA. Results: Patients were female (49.4%) and ≤ 5 years (43.2%). 53% were readmitted in 189 readmission events, most commonly respiratory (30%) and cardiac (21%) related. Those with unfavorable Pediatric Cerebral Performance Category (PCPC) scores at initial discharge were at higher risk for ≥ 3 hospital readmissions compared to those with favorable PCPC scores (RR 5.94 (95% CI 1.50, 23.61)). Unwitnessed compared to witnessed events were associated with an increased risk of ≥ 3 hospital readmissions (RR 2.59 [95% CI 1.26, 5.31]). Upon readmission, half of patients required procedures of which acute, unplanned procedures including intubation, central and arterial line placement were most common. Adjusted to 2017 consumer price index, average charges/hospitalization were $67,005. Over long-term follow-up, the median adjusted total hospital charges/survivor were $123,190 ($11,091-$822,677). Conclusions: This demonstrates that many children who survive OHCA will develop new chronic health conditions requiring hospital readmission and additional procedures. This data should help parents, primary care providers and subspecialists anticipate and address subsequent needs prior to discharge after the arrest. Early coordinated interventions and establishment of effective outpatient services may reduce hospital readmissions and cost.