Intern Med J. 2022 Aug 24. doi: 10.1111/imj.15918. Online ahead of print.
BACKGROUND: Administrative coding of out-of-hospital cardiac arrest (OHCA) is heterogeneous, with the prevalence of non-informative diagnoses uncertain.
METHODS: Hospital discharge diagnoses provided to a state-wide OHCA registry were characterized as either ‘informative’ or ‘non-informative’. ‘Informative’ diagnoses stated an OHCA had occurred or defined OHCA as occurring due to coronary artery disease, cardiomyopathy, channelopathy, definite non-cardiac cause, or no known cause. Non-informative diagnoses were blank, stated presenting cardiac rhythm only, provided irrelevant information or presented a complication of the OHCA as the main diagnosis. Characteristics of patients receiving informative versus non-informative diagnoses were compared.
RESULTS: Of 1,479 OHCA patients aged 1-50 years, 290 patients were admitted to 15 hospitals. 90 diagnoses (31.0%) were non-informative (arrest rhythm = 50, blank = 21, complication = 10, irrelevant = 9). 200 diagnoses (69.0%) were informative (cardiac arrest = 84, coronary artery disease = 54, non-cardiac diagnosis = 48, cardiomyopathy = 8, arrhythmia disorder = 4, unascertained = 2). Only ten diagnoses (3.5%) included both the fact of OHCA and an underlying cause. Patients receiving a non-informative diagnosis were more likely to have survived OHCA or been referred for forensic assessment (p=0.011) and had longer median length of stay (9 vs 5 days, p=0.0019).
CONCLUSION: Almost one-third of diagnoses for young patients discharged after an OHCA included neither the fact of OHCA nor any underlying cause. Under-estimating the burden of OHCA impacts ongoing patient and at-risk family care, data sampling strategies, international statistics and research funding. This article is protected by copyright. All rights reserved.