Grossestreuer, Anne Victoria

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  • Publication
    Sudden Cardiac Arrest: Novel Uses of Risk Standardization and Post-Arrest Body Temperature to Improve Outcomes
    (2016-01-01) Grossestreuer, Anne Victoria
    Sudden cardiac arrest is a leading cause of death and disability in the US, with over 500,000 events annually and <20% surviving to hospital discharge. Half of survivors suffer some degree of neurologic disability from massive ischemic injury and subsequent reperfusion processes. It therefore is vital to evaluate cardiac arrest at both population and clinical levels to improve outcomes. In response, this dissertation had three objectives. First, we examined whether hospital performance could be benchmarked using administrative data, which is more common than registry data. Two risk standardization models were developed using logistic regression involving 2453 patients treated from 2000-2015 at University of Pennsylvania Health System hospitals. Registry and administrative data were accessed for all patients and used to develop separate risk standardization models with survival to hospital discharge as the outcome and the registry model considered the “gold standard.” The administrative model had a receiver operating characteristic (ROC) area of 0.891 (95% CI: 0.876-0.905) compared to a registry area of 0.907 (95% CI: 0.895-0.919), indicating that risk standardization can be performed using administrative data. Second, serial temperatures were collected during the 72 hours following targeted temperature management (TTM) and rewarming on 465 TTM-treated patients from the Penn Alliance for Therapeutic Hypothermia (PATH) registry, of whom 179 (38.5%) had at least one pyrexic temperature (≥38oC). Higher maximum temperature was associated with worse neurologic outcome and lower survival in pyrexic patients. Pyrexia duration and outcomes were not related, unless duration was calculated as hours at or above 38.8oC; at those elevated temperatures, longer duration was associated with worse neurologic and survival outcomes. Third, serial temperatures were collected during the 72 hours post-arrest on 578 PATH patients not treated with TTM; 228 (39.5%) had at least one pyrexic temperature. Worse neurologic and survival outcomes were associated with increasing maximum temperature, the combination of higher maximum temperatures and longer durations at an elevated temperature, and timing of onset of pyrexia between 10.2-24.5 hours post-arrest. This work establishes the potential for using administrative data to create new opportunities to compare hospital performance regarding cardiac arrest and extends knowledge on clinical implications of post-arrest temperature on outcomes.