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Current utilization of interosseous access in pediatrics: a population-based analysis using an EHR database, TriNetX
Meloria Hoskins1, Samantha Sefick2, Adrian D Zurca2
1Penn State College of Medicine, 500 University Drive, P.O. Box 859, Hershey, PA, USA. mhoskins@pennstatehealth.psu.edu.
Insights
Intraosseous (IO) access is a safe alternative for pediatric resuscitation. While more IOs were placed in older children, infants under 1 year had higher mortality, suggesting earlier IO use in this group, even for non-cardiac emergencies.
Area of Science:
- Pediatric Emergency Medicine
- Resuscitation Science
- Vascular Access Techniques
Background:
- Intraosseous (IO) access is a recommended alternative for pediatric resuscitation when intravenous access is delayed.
- Existing studies on pediatric IO use and complications primarily focus on cardiac arrest scenarios.
- Population-based data on non-cardiac indications and age-specific complications of IO access are limited.
Purpose of the Study:
- To investigate the utilization, indications, and complications of intraosseous (IO) access in a diverse pediatric population.
- To compare IO access outcomes between infants (< 1 year) and older children (≥ 1 year).
- To assess the potential underutilization of IO access in non-cardiac pediatric emergencies.
Main Methods:
- Retrospective observational cohort study using electronic health record data from 37 hospitals.
- Included 1012 pediatric patients with reported intraosseous (IO) procedure codes.
- Cohort divided into two age groups: < 1 year and ≥ 1 year.
Main Results:
- Overall incidence of IO line placement was 18 per 100,000 pediatric encounters.
- Higher mortality observed in infants < 1 year (39.2%) compared to older children (29.0%).
- Cardiac arrest was a more frequent indication in infants (< 1 year), while convulsions were more common in older children (≥ 1 year).
- A low overall complication rate of 2.9% was reported.
Conclusions:
- Intraosseous (IO) access was more frequently used in children ≥ 1 year, but infants < 1 year experienced higher mortality.
- Non-cardiac diagnoses (e.g., convulsions, shock, respiratory failure) were infrequently recorded as indications for IO placement, suggesting potential underuse.
- Given the low complication rates, early consideration of IO access is recommended for urgent vascular needs in pediatric patients, particularly infants.
Background:
When central or peripheral intravenous access cannot be achieved in a timely manner, intraosseous (IO) access is recommended as a safe and equally effective alternative for pediatric resuscitation. IO usage and its complications in the pediatric population have been primarily studied in the setting of cardiac arrest. However, population-based studies identifying noncardiac indications and complications associated with different age groups are sparse.
Results:
This was a retrospective observational cohort study utilizing the TriNetX® electronic health record data. Thirty-seven hospitals were included in the data set with 1012 patients where an IO procedure code was reported in the emergency department or inpatient setting. The cohort was split into two groups, pediatric subjects < 1 year of age and those ≥ 1 year of age. A total incidence of IO line placement of 18 per 100,000 pediatric encounters was reported. Total mortality was 31.8%, with a higher rate of mortality seen in subjects < 1 year of age (39.2% vs 29.0%; p = 0.0028). A diagnosis of cardiac arrest was more frequent in subjects < 1 year of age (51.5% vs 38.0%; p = 0.002), and a diagnosis of convulsions was more frequent in those ≥ 1 of age (28.0% vs 13.8%; p <0.01). Overall, 29 (2.9%) subjects had at least one complication.
Conclusions:
More IOs were placed in subjects ≥ 1 year of age, and a higher rate of mortality was seen in subjects < 1 year of age. Lower frequencies of noncardiac diagnoses at the time of IO placement were found in both groups, highlighting IO may be underutilized in noncardiac settings such as convulsions, shock, and respiratory failure. Given the low rate of complications seen in both groups of our study, IO use should be considered early on for urgent vascular access, especially for children less than 1 year of age.
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