| Title |
Effects of modifiable prehospital factors on survival after out-of-hospital cardiac arrest in rural versus urban areas
|
|---|---|
| Published in |
Critical Care, April 2018
|
| DOI | 10.1186/s13054-018-2017-x |
| Pubmed ID | |
| Authors |
Wenche Torunn Mathiesen, Conrad Arnfinn Bjørshol, Jan Terje Kvaløy, Eldar Søreide |
| Abstract |
The modifiable prehospital system factors, bystander cardiopulmonary resuscitation (CPR), emergency medical services (EMS), response time, and EMS physician attendance, may affect short- and long-term survival for both rural and urban out-of-hospital cardiac arrest (OHCA) patients. We studied how such factors influenced OHCA survival in a mixed urban/rural region with a high survival rate after OHCA. We analyzed the association between modifiable prehospital factors and survival to different stages of care in 1138 medical OHCA patients from an Utstein template-based cardiac arrest registry, using Kaplan-Meier type survival curves, univariable and multivariable logistic regression and mortality hazard plots. We found a significantly higher probability for survival to hospital admission (OR: 1.84, 95% CI 1.43-2.36, p < 0.001), to hospital discharge (OR: 1.51, 95% CI 1.08-2.11, p = 0.017), and at 1 year (OR: 1.58, 95% CI 1.11-2.26, p = 0.012) in the urban group versus the rural group. In patients receiving bystander CPR before EMS arrival, the odds of survival to hospital discharge increased more than threefold (OR: 3.05, 95% CI 2.00-4.65, p < 0.001). However, bystander CPR was associated with increased patient survival to discharge only in urban areas (survival probability 0.26 with CPR vs. 0.08 without CPR, p < 0.001). EMS response time ≥ 10 min was associated with decreased survival (OR: 0.61, 95% CI 0.45-0.83, p = 0.002), however, only in urban areas (survival probability 0.15 ≥ 10 min vs. 0.25 < 10 min, p < 0.001). In patients with prehospital EMS physician attendance, no significant differences were found in survival to hospital discharge (OR: 1.37, 95% CI 0.87-2.16, p = 0.17). In rural areas, patients with EMS physician attendance had an overall better survival to hospital discharge (survival probability 0.17 with EMS physician vs. 0.05 without EMS physician, p = 0.019). Adjusted for modifiable factors, the survival differences remained. Overall, OHCA survival was higher in urban compared to rural areas, and the effect of bystander CPR, EMS response time and EMS physician attendance on survival differ between urban and rural areas. The effect of modifiable factors on survival was highest in the prehospital stage of care. In patients surviving to hospital admission, there was no significant difference in in-hospital mortality or in 1 year mortality between OHCA in rural versus urban areas. |
X Demographics
The data shown below were collected from the profiles of 10 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Italy | 2 | 20% |
| United Kingdom | 2 | 20% |
| United States | 1 | 10% |
| Mexico | 1 | 10% |
| Spain | 1 | 10% |
| Canada | 1 | 10% |
| Unknown | 2 | 20% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 4 | 40% |
| Practitioners (doctors, other healthcare professionals) | 3 | 30% |
| Science communicators (journalists, bloggers, editors) | 2 | 20% |
| Scientists | 1 | 10% |
Mendeley readers
The data shown below were compiled from readership statistics for 99 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 99 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Bachelor | 14 | 14% |
| Student > Doctoral Student | 12 | 12% |
| Student > Master | 9 | 9% |
| Researcher | 9 | 9% |
| Other | 7 | 7% |
| Other | 16 | 16% |
| Unknown | 32 | 32% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 28 | 28% |
| Nursing and Health Professions | 17 | 17% |
| Business, Management and Accounting | 3 | 3% |
| Biochemistry, Genetics and Molecular Biology | 3 | 3% |
| Agricultural and Biological Sciences | 2 | 2% |
| Other | 11 | 11% |
| Unknown | 35 | 35% |
Attention Score in Context
This research output has an Altmetric Attention Score of 14. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 07 October 2019.
All research outputs
#2,656,089
of 25,382,440 outputs
Outputs from Critical Care
#2,318
of 6,555 outputs
Outputs of similar age
#54,084
of 340,784 outputs
Outputs of similar age from Critical Care
#60
of 88 outputs
Altmetric has tracked 25,382,440 research outputs across all sources so far. Compared to these this one has done well and is in the 89th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
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