Retrospective chart review and survey to identify adverse safety events in the emergency medical services care of children with out-of-hospital cardiac arrest in the USA: a study protocol

Abstract

IntroductionEfforts to improve the quality of emergency medical services (EMS) care for adults with out-of-hospital cardiac arrest (OHCA) have led to improved survival over time. Similar improvements have not been observed for children with OHCA, who may be at increased risk for preventable adverse safety events during prehospital care. The purpose of this study is to identify patient and organisational factors that are associated with adverse safety events during the EMS care of paediatric OHCA.Methods and analysisThis is a large multisite EMS study in the USA consisting of chart reviews and agency surveys to measure, characterise and evaluate predictors of our primary outcome severe adverse safety events in paediatric OHCA. Using the previously validated Paediatric prehospital adverse Event Detection System tool, we will review EMS charts for 1500 children with OHCA from 2013 to 2019 to collect details of each case and identify severe adverse safety events (ASEs). Cases will be drawn from over 40 EMS agencies in at least five states in geographically diverse areas of the USA. EMS agencies providing charts will also be invited to complete an agency survey to capture organisational characteristics. We will describe the frequency and proportion of severe ASEs in paediatric OHCA across geographic regions and clinical domains, and identify patient and EMS organisational characteristics associated with severe ASEs using logistic regression.Ethics and disseminationThis study has been approved by the Oregon Health & Science University Institutional Review Board (IRB Approval# 00018748). Study results will be disseminated through scientific publications and presentations, and to EMS leaders and staff through local EMS medical directors, quality and training officers and community engagement activities.

A chart review tool to systematically assess the safety of prehospital care for children with out‐of‐hospital cardiac arrest

“…We have previously described the protocol for this study, which adheres to STROBE guidelines and involves a detailed review of EMS electronic charts and a survey of EMS agencies. 13 This study was approved by the OHSU Institutional Review Board (STUDY00018748).…”

“…and evaluated through multiple rounds of comparison of agreement and discussion. The details of this process are noted elsewhere 13 . We created data fields to identify details of key interventions, including whether an intervention was indicated, delayed, or required multiple attempts to successfully complete.…”

“…In our ongoing study, we have developed a robust system for training clinical reviewers and assessing agreement to ensure that we have adequate reliability. 13 However, external generalizability is unknown as this tool has not yet been tested outside of our research group. In addition, the relatively small sample size in this study resulted in wide confidence intervals.…”

“… 6 , 26 Our team has attempted to mitigate these issues through creating a standardized approach to reconcile discrepancies and providing reviewers with the protocols relevant to the years of the study. 13 …”

“…The authors developed and tested a chart review tool to identify severe adverse safety events during the out-of-hospital 13 We created data fields to identify details of key interventions, including whether an intervention was indicated, delayed, or required multiple attempts to successfully complete. We made subsequent minor edits to the PEDS-OHCA tool based on input from our team of 6 chart reviewers who are experts in pediatric emergency or critical care medicine.…”