Frequency and Consequences of Routine Temperature Measurement at Well-Child Visits

OBJECTIVES: To determine the (1) frequency and visit characteristics of routine temperature measurement and (2) rates of interventions by temperature measurement practice and the probability of incidental fever detection. METHODS: In this retrospective cohort study, we analyzed well-child visits between 2014–2019. We performed multivariable regression to characterize visits associated with routine temperature measurement and conducted generalized estimating equations regression to determine adjusted rates of interventions (antibiotic prescription, and diagnostic testing) and vaccine deferral by temperature measurement and fever status, clustered by clinic and patient. Through dual independent chart review, fever (≥100.4°F) was categorized as probable, possible, or unlikely to be incidentally detected. RESULTS: Temperature measurement occurred at 155 527 of 274 351 (58.9%) well-child visits. Of 24 clinics, 16 measured temperature at >90% of visits (“routine measurement clinics”) and 8 at <20% of visits (“occasional measurement clinics”). After adjusting for age, ethnicity, race, and insurance, antibiotic prescription was more common (adjusted odds ratio: 1.21; 95% CI 1.13–1.29), whereas diagnostic testing was less common (adjusted odds ratio: 0.76; 95% CI 0.71–0.82) at routine measurement clinics. Fever was detected at 270 of 155 527 (0.2%) routine measurement clinic visits, 47 (17.4%) of which were classified as probable incidental fever. Antibiotic prescription and diagnostic testing were more common at visits with probable incidental fever than without fever (7.4% vs 1.7%; 14.8% vs 1.2%; P < .001), and vaccines were deferred at 50% such visits. CONCLUSIONS: Temperature measurement occurs at more than one-half of well-child visits and is a clinic-driven practice. Given the impact on subsequent interventions and vaccine deferral, the harm–benefit profile of this practice warrants consideration.

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Self-Reported Vision Impairment and Frailty among Older People with Low Cognitive Performance in Central Africa: EPIDEMCA Population-Based Study

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000518601 ◽

2021 ◽

pp. 1-7

Author(s):

Antoine Gbessemehlan ◽

Gilles Kehoua ◽

Catherine Helmer ◽

Cécile Delcourt ◽

Achille Tchalla ◽

...

Keyword(s):

Older People ◽

Cognitive Performance ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Central Africa ◽

Population Based ◽

Vision Impairment ◽

Sub Saharan Africa ◽

Population Based Study ◽

The Impact

Introduction: Very little is known about the impact of vision impairment (VI) on physical health in late-life in sub-Saharan Africa populations, whereas many older people experience it. We investigated the association between self-reported VI and frailty in Central African older people with low cognitive performance. Methods: It was cross-sectional analysis of data from the Epidemiology of Dementia in Central Africa (EPIDEMCA) population-based study. After screening for cognitive impairment, older people with low cognitive performance were selected. Frailty was assessed using the Study of Osteoporotic Fracture index. Participants who met one of the 3 parameters assessed (unintentional weight loss, inability to do 5 chair stands, and low energy level) were considered as pre-frail, and those who met 2 or more parameters were considered as frail. VI was self-reported. Associations were investigated using multinomial logistic regression models. Results: Out of 2,002 older people enrolled in EPIDEMCA, 775 (38.7%) had low cognitive performance on the screening test. Of them, 514 participants (sex ratio: 0.25) had available data on VI and frailty and were included in the analyses. In total, 360 (70%) self-reported VI. Prevalence of frailty was estimated at 64.9% [95% confidence interval: 60.9%–69.1%] and 23.7% [95% CI: 20.1%–27.4%] for pre-frailty. After full adjustment, self-reported VI was associated with frailty (adjusted odds ratio = 2.2; 95% CI: 1.1–4.3) but not with pre-frailty (adjusted odds ratio = 1.8; 95% CI: 0.9–3.7). Conclusion: In Central African older people with low cognitive performance, those who self-reported VI were more likely to experience frailty. Our findings suggest that greater attention should be devoted to VI among this vulnerable population in order to identify early frailty onset and provide adequate care management.

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B.01 Predictors of dysphagia screening after acute ischemic stroke: Who gets tested?

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.60 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S9-S9

Author(s):

RA Joundi ◽

R Martino ◽

G Saposnik ◽

J Fang ◽

V Giannakeas ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Odds Ratio ◽

Stroke Unit ◽

Adjusted Odds Ratio ◽

Process Of Care ◽

Stroke Registry ◽

Multivariable Regression ◽

Mild Stroke

Background: Dysphagia is a devastating complication of stroke and can lead to malnutrition, immobility, aspiration pneumonia, and death. Guidelines advocate screening all patients with acute stroke for swallowing impairment. However, previous research suggests only 60% are screened, and it is unclear what factors contribute to receiving dysphagia screening. Methods: We used the Ontario Stroke Registry to identify patients who were admitted to Regional Stroke Centres from 2010-2013. We used multivariable regression to identify predictors of receiving a dysphagia screen within 72 hours. Results: Among 7172 patients with acute ischemic stroke, 1705 patients (23.8%) did not undergo screening. Factors increasing the odds of being tested were: Stroke unit admission (adjusted odds ratio aOR 6.5), presenting with speech deficits (aOR 1.9) or weakness (aOR 1.5), or receiving thrombolysis (aOR 1.9). Seizure (aOR 0.49) and mild stroke (aOR 0.59 vs moderate stroke) decreased the odds of being tested. Among those with mild strokes who received a swallowing screen, 33% failed. *All p<0.0001. Conclusions: Patients with mild stroke are at risk of not being screened for dysphagia, despite a significant fail rate among those tested. This may expose untested patients to a higher risk of complications from dysphagia, and suggests a gap in process of care that should be addressed.

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Association between hydroxocobalamin administration and acute kidney injury after smoke inhalation: a multicenter retrospective study

Critical Care ◽

10.1186/s13054-019-2706-0 ◽

2019 ◽

Vol 23 (1) ◽

Cited By ~ 1

Author(s):

François Dépret ◽

Clément Hoffmann ◽

Laura Daoud ◽

Camille Thieffry ◽

Laure Monplaisir ◽

...

Keyword(s):

Acute Kidney Injury ◽

Retrospective Study ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Kidney Injury ◽

Smoke Inhalation ◽

Logistic Regression Models ◽

Increased Risk ◽

The Impact

Abstract Background The use of hydroxocobalamin has long been advocated for treating suspected cyanide poisoning after smoke inhalation. Intravenous hydroxocobalamin has however been shown to cause oxalate nephropathy in a single-center study. The impact of hydroxocobalamin on the risk of acute kidney injury (AKI) and survival after smoke inhalation in a multicenter setting remains unexplored. Methods We conducted a multicenter retrospective study in 21 intensive care units (ICUs) in France. We included patients admitted to an ICU for smoke inhalation between January 2011 and December 2017. We excluded patients discharged at home alive within 24 h of admission. We assessed the risk of AKI (primary endpoint), severe AKI, major adverse kidney (MAKE) events, and survival (secondary endpoints) after administration of hydroxocobalamin using logistic regression models. Results Among 854 patients screened, 739 patients were included. Three hundred six and 386 (55.2%) patients received hydroxocobalamin. Mortality in ICU was 32.9% (n = 243). Two hundred eighty-eight (39%) patients developed AKI, including 186 (25.2%) who developed severe AKI during the first week. Patients who received hydroxocobalamin were more severe and had higher mortality (38.1% vs 27.2%, p = 0.0022). The adjusted odds ratio (95% confidence interval) of AKI after intravenous hydroxocobalamin was 1.597 (1.055, 2.419) and 1.772 (1.137, 2.762) for severe AKI; intravenous hydroxocobalamin was not associated with survival or MAKE with an adjusted odds ratio (95% confidence interval) of 1.114 (0.691, 1.797) and 0.784 (0.456, 1.349) respectively. Conclusion Hydroxocobalamin was associated with an increased risk of AKI and severe AKI but was not associated with survival after smoke inhalation. Trial registration ClinicalTrials.gov, NCT03558646

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Impact of simplified therapeutic guidelines on antibiotic prescriptions: a prospective multicentre comparative study

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz490 ◽

2019 ◽

Vol 75 (3) ◽

pp. 747-755

Author(s):

Pierre-Marie Roger ◽

Ingrid Peyraud ◽

Michel Vitris ◽

Valérie Romain ◽

Laura Bestman ◽

...

Keyword(s):

Clavulanic Acid ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Third Generation ◽

Therapeutic Guidelines ◽

Amoxicillin Clavulanic Acid ◽

The Impact ◽

Third Generation Cephalosporins

Abstract Objectives We studied the impact of simplified therapeutic guidelines (STGs) associated with accompanied self-antibiotic reassessment (ASAR) on antibiotic use. Methods Prospective antibiotic audits and feedback took place at 15 hospitals for 12 months, allowing STGs with ≤15 drugs to be devised. STGs were explained to prescribers through sessions referred to as ASAR. Optimal therapy was defined by the conjunction of a diagnosis and the drug specified in the STGs. Analysis of consumption focused on critical drugs: amoxicillin/clavulanic acid, third-generation cephalosporins and fluoroquinolones. Results We compared prescriptions in five hospitals before (n = 179) and after (n = 168) the implementation of STGs + ASAR. These tools were associated with optimal therapies and amoxicillin/clavulanic acid prescriptions [adjusted odds ratio (AOR) 3.28, 95% CI 1.82–5.92 and 2.18, 95% CI 1.38–3.44, respectively] and fewer prescriptions for urine colonization [AOR 0.20 (95% CI 0.06–0.61)]. Comparison of prescriptions (n = 1221) from 10 departments of three clinics with STGs + ASAR for the first quarters of 2018 and 2019 revealed that the prescriptions by 23 ASAR participants more often complied with STGs than those by 28 other doctors (71% versus 60%, P = 0.003). STGs alone were adopted by 10 clinics; comparing the prescriptions (n = 311) with the 5 clinics with both tools, we observed fewer unnecessary therapies in the latter [AOR 0.52 (95% CI 0.34–0.80)]. The variation in critical antibiotic consumption between 2017 and 2018 was −16% for the 5 clinics with both tools and +20% for the other 10 (P = 0.020). Conclusions STGs + ASAR promote optimal antibiotic therapy and reduce antibiotic use.

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Targeted therapy at the end of life and the impact on health care utilization.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.116 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 116-116

Author(s):

Heidi Yeung ◽

Parsa Salehi ◽

James Don Murphy

Keyword(s):

Targeted Therapy ◽

End Of Life ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Large Population ◽

Metastatic Breast ◽

Care Utilization ◽

Study Cohort ◽

Ed Visits ◽

The Impact

116 Background: The use of targeted therapy has steadily increased over the past decade, though the impact of targeted agents on patterns of care at the end-of-life life remains unknown. The purpose of this study was to explore the influence of targeted therapy on end-of-life care in a large population-based database. Methods: We identified 14,398 patients from the SEER-Medicare linked database with metastatic breast, lung, or colorectal cancer diagnosed between 2000 and 2009 who received conventional cytotoxic chemotherapy or targeted therapy in the last 3 months of life. Multivariate logistic and linear regression models were used to determine the impact of targeted therapy on the following endpoints in the last 3 months of life: emergency department (ED) visits, hospitalizations, and hospice utilization. Analyses were adjusted for differences in patient age, gender, race, comorbidity, socioeconomic status, and geography. Results: Among the whole study cohort 83% of patients received chemotherapy alone, 12% received chemotherapy with targeted therapy, and 5% received targeted therapy alone. The delivery of any targeted therapy in the last 3 months increased across the study period, from 1.5% in 2000 to 28% in 2009. Compared to patients treated with chemotherapy alone, those treated with targeted therapy alone had lower rates of ED visits (adjusted odds ratio [aOR]=0.81, p=0.01), lower rates of hospitalization (adjusted odds ratio [aOR]=0.69, p<0.0001), no difference in overall hospice utilization rates, though had longer stays on hospice (5.1 days longer, p<0.0001). Compared to patients treated with chemotherapy alone, those treated with both chemotherapy and targeted therapy had no difference in ED visits or hospitalization admission rates, though had decreased rates of hospice utilization (aOR = 0.79, p<0.0001), and shorter stays on hospice (2.7 days longer, p<0.0001). Conclusions: This study found that targeted therapy was associated with varying patterns of healthcare utilization at the end-of-life, though these differences could be influenced by unknown confounding variables. Future research should focus on defining the specific impact of targeted therapy on quality of life at the end-of-life.

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Epidemiology of acute rubella infection in Zambia during the pre-vaccination period (2005 – 2016) as a baseline for monitoring rubella epidemiology in the post-rubella vaccine introduction era

10.21203/rs.2.9744/v4 ◽

2019 ◽

Author(s):

Mazyanga Lucy Mazaba ◽

Seter Siziya ◽

Mwaka Monze ◽

Daniel Cohen

Keyword(s):

Odds Ratio ◽

Adjusted Odds Ratio ◽

Laboratory Data ◽

Health Concern ◽

Age Group ◽

Childbearing Age ◽

Rubella Vaccine ◽

Vaccine Introduction ◽

Hot Dry Season ◽

The Impact

Abstract Background: Rubella is highly under reported in Zambia as in most sub-Saharan countries despite being a disease of major public health concern especially among women of childbearing age. In September 2016, Zambia introduced a combined measles-rubella vaccine in children 0-14 years. In this study, we estimated the proportion positive for acute rubella among suspected but negative measles cases between 2005 and 2016 and determined its correlates for monitoring rubella epidemiology post-rubella vaccine introduction. Methods: In a retrospective study, 4497 measles IgM negative serum samples from 5686 clinically suspected measles cases were examined for rubella IgM antibodies using the Siemens, Enzygnost® ELISA kit at the national measles laboratory. Data on demographics, year and month of onset were extracted from the surveillance data. Multivariate logistic regression analysis using backward variable selection was conducted to determine independent predictors for acute rubella. The magnitude of association was estimated using adjusted odds ratio with a 95% confidence interval. Results: Overall, a proportion of 29.2% (1313/4497) affecting mostly those between 5 and 24 years was determined. Only age, province, month and year were independently associated with acute rubella. The regional proportions varied from 21.8 – 37.3% peaking in the month of October. Persons in the age group 10-14 years (Adjusted Odds Ratio [AOR]=2.43; 95% CI [2.01 - 2.95]) were more likely while those aged <1 year less likely (AOR=0.31; 95% CI [021 - 0.48]) to have acute rubella compared to those aged 25 years or older. Persons in 2010 were less likely (AOR=0.12; CI [0.05, 0.28]) to have acute rubella compared to those in 2016. While acute rubella was more likely to occur between July and November compared to December, it was less likely to occur between February and May. Conclusions: Rubella virus was circulating in Zambia between 2005 and 2016 affecting mostly persons in the age group 5-24 years peaking in the hot dry season month of October. Although vaccination against rubella has been launched, these baseline data are important to provide a reference point when determining the impact of the vaccination program implemented. Keywords: Rubella, Acute, Proportion, Correlates, Zambia, Pre vaccination era, Immunisation

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Disclosure of HIV seropositivity to sexual partner in Ethiopia: A systematic review

Women s Health ◽

10.1177/17455065211063021 ◽

2021 ◽

Vol 17 ◽

pp. 174550652110630

Author(s):

Aklilu Endalamaw ◽

Yibeltal Assefa ◽

Demeke Geremew ◽

Habte Belete ◽

Berihun Assefa Dachew ◽

...

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Sexual Partners ◽

Hiv Positive ◽

People Living With Hiv ◽

Hiv Status ◽

Living With Hiv ◽

Status Disclosure ◽

The Impact

Introduction: In Ethiopia, the burden of HIV/AIDS is a public health issue that requires significant control of transmission. Once an infection has been established, determinants influence people living with HIV to disclose or not their HIV-positive status to sexual partners. This study assessed the proportion and associated factors of people living with HIV’s disclosure status to sexual partners. Methods: CRD42020149092 is the protocol’s registration number in the PROSPERO database. We searched PubMed, Scopus, African Journals Online, and Google Scholar databases. For the subjective and objective assessment of publication bias, we used a funnel plot and Egger’s regression test, respectively. The I2 statistic was used to assess variation across studies. Meta-analysis of weighted inverse variance random-effects model was used to estimate the pooled proportion. We conducted subgroup and sensitivity analyses to investigate the cause of heterogeneity and the impact of outliers on the overall estimation, respectively. A trend analysis was also performed to show the presence of time variation. Results: The percentage of people living with HIV who disclosed their HIV-positive status to sexual partners was 76.03% (95% confidence interval: 68.78, 83.27). Being on antiretroviral therapy (adjusted odds ratio = 6.19; 95% confidence interval: 2.92, 9.49), cohabiting with partner (adjusted odds ratio = 4.48; 95% confidence interval: 1.24, 7.72), receiving HIV counseling (adjusted odds ratio = 3.94; 95% confidence interval: 2.08, 5.80), having discussion prior to HIV testing (adjusted odds ratio = 4.40; 95% confidence interval: 2.11, 6.69), being aware of partner’s HIV status (adjusted odds ratio = 6.08; 95% confidence interval: 3.05, 9.10), positive relationship with partner (adjusted odds ratio = 4.44; 95% confidence interval:1.28, 7.61), and being member of HIV association (adjusted odds ratio = 3.70; 95% confidence interval: 2.20, 5.20) had positive association with HIV status disclosure. Conclusion: In Ethiopia, more than one-fourth of adults living with HIV did not disclose their HIV-positive status to sexual partners. HIV-positive status disclosure was influenced by psychosocial factors. A multidimensional approach is required to increase seropositive disclosure in Ethiopia.

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Racial Disparities in the Incidence of Pulmonary Embolism after Colectomy

The American Surgeon ◽

10.1177/000313481808401004 ◽

2018 ◽

Vol 84 (10) ◽

pp. 1560-1564 ◽

Cited By ~ 1

Author(s):

Yas Sanaiha ◽

Katherine L. Bailey ◽

Esteban Aguayo ◽

Young-Ji Seo ◽

Vishal Dobaria ◽

...

Keyword(s):

Pulmonary Embolism ◽

Confidence Interval ◽

Odds Ratio ◽

National Study ◽

Surgical Quality ◽

Black Patients ◽

Chi Squared ◽

Multivariable Regression ◽

The Impact ◽

Hospital Characteristics

Disparities in the incidence of pulmonary embolism (PE) based on racial and socioeconomic factors remain ill-defined. The present study evaluated the impact of race and hospital characteristics on rates of PE for all adult colectomy patients in the 2005 to 2014 Nationwide Inpatient Sample. Hospitals were designated as high-burden hospitals (HBHs) or low-burden hospitals of underinsured payers. Chi-squared tests of trend and multivariable regression adjusting for patient and hospital characteristics were performed. Of the 2,737,977 adult patients who underwent colectomy in the study period, 79 per cent were White, 10 per cent Black, and 7 per cent Hispanic. The annual rate of PE increased from 0.6 per cent in 2005 to 0.95 per cent in 2014 ( P < 0.0001). Black patients had significantly higher incidence of PE than Whites (1.5% vs 0.9%, P < 0.001) and Hispanics (1.5% vs 0.8%, P < 0.001). Colectomy at HBHs was also associated with significantly higher rates of PE (1% vs 0.86%, P < 0.001). After adjusting for baseline differences, colectomy at HBHs (odds ratio 1.14, 95% confidence interval 1.02–1.27, P = 0.02) and Black race (odds ratio 1.4, 95% confidence interval 1.26–1.66, P < 0.001) were independent predictors of PE. In this national study of colectomy patients, Black patients experienced a disproportionate burden of postoperative PE. Further investigation into the causes and prevention of PE in vulnerable populations may identify targets for surgical quality improvement.

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Impact of Antiplatelet Therapy During Endovascular Therapy for Tandem Occlusions

Stroke ◽

10.1161/strokeaha.119.028231 ◽

2020 ◽

Vol 51 (5) ◽

pp. 1522-1529 ◽

Cited By ~ 8

Author(s):

François Zhu ◽

Mohammad Anadani ◽

Julien Labreuche ◽

Alejandro Spiotta ◽

Francis Turjman ◽

...

Keyword(s):

Carotid Artery ◽

Antiplatelet Therapy ◽

Endovascular Therapy ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

De Novo ◽

Antiplatelet Agent ◽

Favorable Outcome ◽

Anterior Circulation ◽

The Impact

Background and Purpose— Antiplatelet agents could be used in the setting of endovascular therapy for tandem occlusions to reduce the risk of de novo intracranial embolic migration, reocclusion of the extracranial internal carotid artery lesion, or in-stent thrombosis in case of carotid stent placement but have to be balanced with the intracerebral hemorrhagic transformation risk. In this study, we aim to investigate the impact of acute antiplatelet therapy administration on outcomes during endovascular therapy for anterior circulation tandem occlusions. Methods— This is a retrospective analysis of a collaborative pooled analysis of 11 prospective databases from the multicenter observational TITAN registry (Thrombectomy in Tandem Lesions). Patients were divided into groups based on the number of antiplatelet administered during endovascular therapy. The primary outcome was favorable outcome, defined as a modified Rankin Scale score of 0 to 2 at 90 days. Results— This study included a total of 369 patients; 145 (39.3%) did not receive any antiplatelet agent and 224 (60.7%) received at least 1 antiplatelet agent during the procedure. Rate of favorable outcome was nonsignificantly higher in patients treated with antiplatelet therapy (58.3%) compared with those treated without antiplatelet (46.0%; adjusted odds ratio, 1.38 [95% CI, 0.78–2.43]; P =0.26). Rate of 90-day mortality was significantly lower in patients treated with antiplatelet therapy (11.2% versus 18.7%; adjusted odds ratio, 0.47 [95% CI, 0.22–0.98]; P =0.042), without increasing the risk of any intracerebral hemorrhage. Successful reperfusion (modified Thrombolysis in Cerebral Ischemia score 2b-3) rate was significantly better in the antiplatelet therapy group (83.9% versus 71.0%; adjusted odds ratio, 1.89 [95% CI, 1.01–3.64]; P =0.045). Conclusions— Administration of antiplatelet therapy during endovascular therapy for anterior circulation tandem occlusions was safe and was associated with a lower 90-day mortality. Optimal antiplatelet therapy remains to be assessed, especially when emergent carotid artery stenting is performed. Further randomized controlled trials are needed.

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LO08: Effect of an intact “chain of survival” sequence on survival to discharge from out-of-hospital cardiac arrest

CJEM ◽

10.1017/cem.2017.70 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S30

Author(s):

D.L. Andrusiek ◽

R.B. Abu-Laban ◽

J.M. Tallon ◽

S. Sheps ◽

K. Joseph

Keyword(s):

Cardiac Arrest ◽

Hospital Discharge ◽

Endotracheal Intubation ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Research Network ◽

Independent Effect ◽

Chain Of Survival ◽

The Impact ◽

Hospital Cardiac Arrest

Introduction: The “chain of survival” is a 5-link theoretical construct that has been central to cardiac arrest resuscitation for over 40 years. Although the role of each link has been extensively studied, little is known about the impact of performing the chain of survival in sequence. The purpose of this study was to estimate the proportion of out-of-hospital cardiac arrest (OHCA) responses by Emergency Medical Services (EMS) that had an intact chain of survival sequence response, and the effect of this on survival to hospital discharge. Methods: We conducted a prospective cohort study of adult (>age 20 years) OHCA patients using data collected between 2005-2007 by the Resuscitation Outcomes Consortium (ROC). ROC is a research network involving 10 research sites and 264 EMS agencies across North America. Using routinely collected data, we coded cases as receiving an intact or non-intact chain of survival sequence based on EMS cardio pulmonary resuscitation (CPR), rhythm analysis or defibrillation, epinephrine administration or endotracheal intubation, and transport to a hospital with an electrophysiology lab or percutaneous coronary intervention capability, contingent on the patient’s condition when EMS arrived. Multiple variable logistic regression was performed, adjusting for known (Utstein) survival predictors, to estimate the independent effect of intact chain of survival sequence on survival to hospital discharge. REB approval was obtained. Results: We enrolled12,821 OHCA cases, of which, 29.4% (n=3,773) had an intact chain of survival and 7.6% (n=972) survived to hospital discharge. Cases with an intact chain of survival were younger, and more likely to arrest in public, receive bystander CPR, occur in the USA and specific ROC sites, and had faster EMS response times. The adjusted odds ratio of survival to hospital discharge with an intact chain of survival sequence was 2.4 (95% CI: 2.1-2.8). A sensitivity analysis of 4,056 cases with known timing of endotracheal intubation found a similar adjusted odds ratio of 2.1 (95% CI: 1.6-2.8). Conclusion: Our results indicate that OCHA resuscitation with an intact chain of survival occurs in approximately 1/3 of cases, and results in over a two-fold increase in the odds of surviving to hospital discharge. Initiatives to improve EMS teamwork and increase the proportion of OHCA resuscitation with an intact chain of survival appear to be warranted.

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