Abstract 10: Regional Variation in Out-Of-Hospital Cardiac Arrest Survival in the United States
Bibliographic record
Abstract
Background: Although previous studies have shown marked variation in out-of-hospital cardiac arrest survival across U.S. regions, factors underlying this variation in survival remain unknown. Methods & Results: Using 2005-2013 data from the Cardiac Arrest Registry to Enhance Survival (CARES), we identified 88,305 adult patients (age >18 years) in 107 U.S. counties with out-of-hospital cardiac arrest at home or in a public location, and geo-coded them to a U.S. county using the address where cardiac arrest occurred We constructed a two-level hierarchical regression model (patient & county) and used median odds ratios (MOR) to quantify regional variation in out-of-hospital cardiac arrest survival. Moreover, we examined the proportion of variation in survival that was explained by 1) patient demographics 2) cardiac arrest characteristics 3) county-level rates of bystander cardiopulmonary resuscitation (CPR) and hypothermia treatment and 4) county-level socio-demographic factors. The mean rate of survival to discharge was 10.0%, and varied markedly across counties (range: 1.4%-18.4%, MOR: 1.33; 95% CI: 1.24-1.38, Figure 1). Compared to counties in the lowest quartile of survival, patients in the highest quartile counties were younger (62.5 vs 61.6 years), more likely to be men (60.8% vs 64.4%), have a shockable rhythm (21.1% vs 26.9%), witnessed arrest (50.3% vs 53.0%), receive bystander CPR (23.4% vs 32.6%), and hypothermia (44.4% vs 62.3%, P for trend < 0.01 for all). County-level rates of survival were positively correlated with rates of bystander CPR (ρ = 0.45, P < 0.0001) and hypothermia treatment (ρ = 0.24, P < 0.0001). Sequential adjustment of demographic and cardiac arrest characteristics explained only 4.3% and 12.4% of the county-level variation in survival, respectively. Inclusion of county-level rates of bystander CPR and hypothermia explained a total of 28.5% of the survival variation, and this proportion increased to 36% after adjustment of other county-level factors. Conclusion: There is substantial variation in out-of-hospital cardiac arrest survival across U.S. counties. Although a large proportion of survival variation was unexplained, most of the variation that could be accounted for was due to county-level differences in rates of bystander CPR and hypothermia treatment.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".