Evidence map›Paper›PMID 31567402›Full record

ArticleCritical care medicine2020

Racial and Ethnic Disparities in Postcardiac Arrest Targeted Temperature Management Outcomes.

Claire S Jacobs, Louis Beers, Suna Park, Benjamin Scirica, Galen V Henderson, Liangge Hsu, Matthew Bevers, Barbara A Dworetzky, Jong Woo Lee

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Critical care medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Claire S JacobsDepartment of Neurology, Massachusetts General Hospital, Boston, MA.
Louis BeersDepartment of Neurology, Brigham and Women's Hospital, Boston, MA.
Suna ParkDepartment of Neurology, Brigham and Women's Hospital, Boston, MA.
Benjamin SciricaDepartment of Medicine, Division of Cardiology, Brigham and Women's Hospital, Boston, MA.
Galen V HendersonDepartment of Neurology, Brigham and Women's Hospital, Boston, MA.
Liangge HsuDepartment of Radiology, Brigham and Women's Hospital, Boston, MA.
Matthew BeversDepartment of Neurology, Brigham and Women's Hospital, Boston, MA.
Barbara A DworetzkyDepartment of Neurology, Brigham and Women's Hospital, Boston, MA.
Jong Woo LeeDepartment of Neurology, Brigham and Women's Hospital, Boston, MA.

Funding

Neuroscience Resident Research ProgramR25NS065743 · NINDS · MASSACHUSETTS GENERAL HOSPITAL · PI CASH, SYDNEY S, WILLIAMS, ZIV · 2009 to 2023
$11.8M
Imaging regional gene expression variability in brain tumor associated seizuresR03NS091864 · NINDS · BRIGHAM AND WOMEN'S HOSPITAL · PI LEE, JONG WOO · 2015 to 2016
$177k
NINDS NIH HHS R03 NS091864NINDS NIH HHS R25 NS065743
6 · The paper itself

Abstract

objectivesTo evaluate racial and ethnic disparities in postcardiac arrest outcomes in patients undergoing targeted temperature management.

designRetrospective study.

settingICUs in a single tertiary care hospital. PATIENTS: Three-hundred sixty-seven patients undergoing postcardiac arrest targeted temperature management, including continuous electroencephalogram monitoring.

interventionsNone. MEASUREMENTS AND MAIN

resultsClinical variables examined in our clinical cohort included race/ethnicity, age, time to return of spontaneous circulation, cardiac rhythm at time of arrest, insurance status, Charlson Comorbidity Index, and time to withdrawal of life-sustaining therapy. CT at admission and continuous electroencephalogram monitoring during the first 24 hours were used as markers of early injury. Outcome was assessed as good (Cerebral Performance Category 1-2) versus poor (Cerebral Performance Category 3-5) at hospital discharge. White non-Hispanic ("White") patients were more likely to have good outcomes than white Hispanic/nonwhite ("Non-white") patients (34.4 vs 21.7%; p = 0.015). In a multivariate model that included age, time to return of spontaneous circulation, initial rhythm, combined electroencephalogram/CT findings, Charlson Comorbidity Index, and insurance status, race/ethnicity was still independently associated with poor outcome (odds ratio, 3.32; p = 0.003). Comorbidities were lower in white patients but did not fully explain outcomes differences. Nonwhite patients were more likely to exhibit signs of early severe anoxic changes on CT or electroencephalogram, higher creatinine levels and receive dialysis, but had longer duration to withdrawal of lifesustaining therapy. There was no significant difference in catheterizations or MRI scans. Subgroup analysis performed with patients without early electroencephalogram or CT changes still revealed better outcome in white patients.

conclusionsRacial/ethnic disparity in outcome persists despite a strictly protocoled targeted temperature management. Nonwhite patients are more likely to arrive with more severe anoxic brain injury, but this does not account for all the disparity.

Indexed as

EthnicityHealth Status DisparitiesHypothermia, InducedRacial GroupsAdultAgedFemaleHeart ArrestHumansMaleMiddle AgedRetrospective StudiesTreatment Outcome

Identifiers

PMID31567402
PMCPMC6910990

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