(722) Characteristics and Risk Factors of Readmission After Pediatric Out-of-Hospital Cardiac Arrest

Introduction: Cardiac arrest in children is rare but carries high morbidity and mortality. Hospital readmissions are detrimental to recovery of survivors and can be a target for improving care delivery, but the characteristics of readmission in this population are unknown. We sought to describe the reasons for, and factors associated with, these hospitalizations.

Methods: Using the National Readmissions Database from the Healthcare Utilization Project (2016-2019) we identified children who survived hospitalization following an out-of-hospital cardiac arrest using a validated algorithm. We stratified the index OHCA hospitalization into cardiac and non-cardiac etiology using the Clinical Classifications Software Revised for ICD-10. A cardiac etiology was defined by either a primary diagnostic code indicating “cardiac arrest with underlying cardiac cause”, or any code indicating specific underlying conditions such as cardiac arrhythmia, cardiomyopathy, or myocarditis. Our primary outcome was 30-day hospital readmission. Patient and hospital characteristics associated with readmission were analyzed using Wilcoxon rank sum and chi square tests as appropriate.

Results: We identified 1,709 pediatric OHCA admissions eligible for 30-day readmission analysis. Of these, 1,325 (77%) had a primary cardiac etiology. Among all index OHCA cases, 229 (13%) had a readmission within 30 days of discharge. Readmission rates did not differ based on arrest etiology (13.7% cardiac vs. 11.7% non-cardiac, p=0.31), but there were differences in the reasons for readmissions. Cardiac arrhythmia, respiratory failure, and chemotherapy were top reasons for readmission in the primary cardiac cohort. Respiratory failure, epilepsy, and respiratory symptoms were most common among the non-cardiac cohort. Hospitalizations with 30-day readmission were among younger children (p < 0.01) and those with longer lengths of stay (p < 0.01).

Conclusions: In a national cohort of almost 2000 children who survived to hospitalization for OHCA, over 1 in 8 children were readmitted within 30 days of discharge. Readmission diagnoses differed by etiology of cardiac arrest and were more likely to occur in younger patients with longer index hospitalizations. Thus, anticipatory guidance for survivors may be tailored to the individual.