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Current utilization of interosseous access in pediatrics: a population-based analysis using an EHR database, TriNetX.

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Summary

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.

Keywords:
ComplicationsCritical careEmergent accessInterosseousNeonatesPediatrics

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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.