Observational studyPediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies2026
Real-Time Assessment of Factors Impacting Prognostic Predictions After Pediatric Cardiac Arrest: A Single-Center Prospective Study.
Observational study in Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesChildren who suffer cardiac arrest are at risk of mortality and morbidity, with survivors often experiencing a severe decline in neurobehavioral function. Despite challenges in neuroprognostication, providers frequently make predictions regarding patient recovery that influence outcomes. We aimed to determine the clinical factors providers report using in real time to predict patient survival and neurologic outcomes at discharge, and how these factors differ by provider and patient characteristics, and time from arrest.
designSingle center prospective observational study.
settingThe Children's Hospital of Philadelphia PICU over 12 months, 2023-2024. PATIENTS: Children resuscitated from in-hospital cardiac arrest and out-of-hospital cardiac arrest (OHCA) who received post-arrest care in the PICU. SUBJECTS: Multidisciplinary providers of post-cardiac arrest patients.
interventionsNone. MEASUREMENTS AND MAIN
resultsMultidisciplinary team members completed questionnaires on post-arrest days 1, 2, 3, and 7, eliciting demographic data and factors used to form their prediction. Descriptive statistics summarized patient characteristics, provider demographics, and survey data. Mixed-effect models explored changes in factors used for the prediction of patient discharge outcome over survey time points, as well as differences by provider and patient characteristics. Overall, 64 patients (median age, 4.1 yr [interquartile range, 1.2-9.4 yr]; 60% OHCA; and 55% pre-arrest Pediatric Cerebral Performance Category = 1) were analyzed. Five hundred forty-eight questionnaires were completed by 245 unique providers. Across all time points, baseline neurologic function and clinical neurologic examination were the most frequently reported factors used to inform prognosis. Use of intra-arrest factors decreased, while reliance on neuromonitoring and neuroimaging increased over time. Factor use varied by provider discipline and patient and arrest characteristics.
conclusionsPrognostic predictions after pediatric cardiac arrest were dynamic and influenced by both patient characteristics and provider discipline. Future efforts should aim to understand how the integration of patient data impacts prognostic accuracy and clarify how prognostic impressions shape communication and decision-making with caregivers.
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