This study aims to identify demographic factors, area-based social determinants of health (SDOH), and clinical features associated with medical decision-making after pediatric out-of-hospital cardiac arrest (OHCA). This is a retrospective, exploratory, descriptive analysis of patients < 18 years old admitted to the pediatric intensive care unit (ICU) after OHCA from 2011 to 2022 (n = 217) at an urban tertiary care, free-standing children’s hospital. Outcomes of interest included: (1) whether a new advance care plan (ACP) (defined as a written advance directive including do not resuscitate and/or do not intubate) was ordered during hospitalization, and (2) whether the patient was discharged with new medical technology (defined as tracheostomy and/or feeding tube). Logistic regression models identified features associated with these outcomes. Of the 217 patients, 78 patients (36%) had a new ACP placed during their admission. Of the survivors, 26% (27/102) were discharged home with new medical technology. Factors associated with ACP were greater change in Pediatric Cerebral Performance Category (PCPC) score (aOR = 1.49, 95% CI [1.28–1.73], p-value < 0.001) and palliative care consultation (aOR = 2.39, 95% CI [1.16–4.89], p-value 0.018). Factors associated with new medical technology were lower change in PCPC score (aOR = 0.76, 95% C.I. [0.61–0.95], p-value = 0.015) and palliative care consultation (aOR = 7.07, 95% CI [3.01–16.60], p-value < 0.001). There were no associations between area-based SDOH and outcomes. Understanding factors associated with decision-making related to ACP after OHCA is critical to optimize counseling for families. Multi-institutional studies are warranted to identify whether these findings are generalizable.

中文翻译：

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儿科院外心脏骤停后家庭决策的相关因素


本研究旨在确定人口因素、基于地区的健康社会决定因素 (SDOH) 以及与儿科院外心脏骤停 (OHCA) 后医疗决策相关的临床特征。这是对 2011 年至 2022 年在城市三级护理独立儿童医院接受 OHCA 后入住儿科重症监护病房 (ICU) 的 <18 岁患者 (n = 217) 进行的回顾性、探索性、描述性分析。感兴趣的结果包括：(1) 住院期间是否下令制定新的预先护理计划 (ACP)（定义为书面预先指示，包括不复苏和/或不插管），以及 (2) 患者是否出院新的医疗技术（定义为气管切开术和/或饲管）。逻辑回归模型确定了与这些结果相关的特征。在 217 名患者中，78 名患者 (36%) 在入院期间放置了新的 ACP。在幸存者中，26% (27/102) 通过新的医疗技术出院回家。与 ACP 相关的因素包括儿科脑功能类别 (PCPC) 评分（aOR = 1.49，95% CI [1.28–1.73]，p 值 < 0.001）和姑息治疗咨询（aOR = 2.39，95% CI [1.16]）的较大变化。 –4.89]，p 值 0.018）。与新医疗技术相关的因素包括 PCPC 评分变化较小（aOR = 0.76，95% CI [0.61–0.95]，p 值 = 0.015）和姑息治疗咨询（aOR = 7.07，95% CI [3.01–16.60]， p 值 < 0.001)。基于地区的 SDOH 与结果之间没有关联。了解 OHCA 后与 ACP 相关决策相关的因素对于优化家庭咨询至关重要。有必要进行多机构研究来确定这些发现是否具有普遍性。