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Epidemiology and outcomes of cardiac arrest among children with Down Syndrome: a multicenter analysis
Asif Padiyath1, Mallikarjuna Rettiganti2, Jeffrey M Gossett2
1Division of Pediatric Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Insights
Children with Down syndrome have a higher risk of cardiac arrest but lower mortality after cardiac arrest compared to peers. This study examines cardiac arrest incidence and outcomes in critically ill children with and without Down syndrome.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiology
- Genetics and Genomics
Background:
- Down syndrome prevalence is increasing globally.
- Outcomes after pediatric cardiac arrest (CA) in children with Down syndrome are not well-established.
- This study evaluates CA epidemiology and mortality in critically ill children with and without Down syndrome.
Purpose of the Study:
- To assess the association between Down syndrome and the incidence of cardiac arrest in critically ill children.
- To determine the impact of Down syndrome on mortality rates following cardiac arrest in pediatric intensive care units.
- To analyze the epidemiological differences in cardiac arrest and its outcomes between children with and without Down syndrome.
Main Methods:
- Utilized data from the Pediatric Health Information Systems (PHIS) database from 2004-2014.
- Included pediatric patients (≤18 years) admitted to participating Intensive Care Units.
- Employed multivariable logistic regression to adjust for patient and center characteristics.
Main Results:
- Analyzed 849,250 patients; 25,143 had Down syndrome.
- Patients with Down syndrome showed a higher likelihood of cardiac arrest (OR: 1.14, P=0.01).
- Despite higher CA incidence, patients with Down syndrome had lower in-hospital mortality post-cardiac arrest (OR: 0.78, P=0.02).
Conclusions:
- Incidence of cardiac arrest and post-arrest mortality vary significantly between children with and without Down syndrome.
- Children with Down syndrome face a higher risk of cardiac arrest but experience better survival rates after arrest.
- Further research is warranted to understand the mechanisms behind these observed differences in outcomes.
Background:
With the increasing prevalence of Down Syndrome, it is unknown if children with Down Syndrome are associated with increased incidence of cardiac arrest and poor outcomes after cardiac arrest. The objective of this study was to evaluate the epidemiology of cardiac arrest and mortality after cardiac arrest among critically ill children with and without Down Syndrome.
Methods:
Patients ≤18 years admitted at a Pediatric Health Information Systems (PHIS) participating Intensive Care Unit were included (2004-2014). Multivariable logistic regression models were fitted to evaluate association of Down Syndrome with study outcomes after adjusting for patient and center characteristics.
Results:
A total of 849,250 patients from 44 centers were included. Of the 25,143 patients with Down Syndrome, cardiac arrest was noted among 568 (2.3%) patients with an associated mortality at hospital discharge of 248 (43.6%) patients. In contrast, of the 824,107 patients without Down Syndrome, cardiac arrest was noted among 15,822 (1.9%) patients with an associated mortality at hospital discharge of 7775 (49.1%) patients. In adjusted models, patients with Down Syndrome had a higher likelihood of having cardiac arrest as compared to patients without Down Syndrome (with vs. without Down, OR: 1.14, 95% CI: 1.03-1.25, P=0.01). Despite having a higher likelihood of cardiac arrest, patients with Down Syndrome were associated with a lower mortality after cardiac arrest (OR: 0.78, 95% CI: 0.63-0.96, P=0.02).
Conclusions:
Both incidence of cardiac arrest, and mortality at hospital discharge in those with cardiac arrest vary substantially in children with and without Down Syndrome.
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