Identifying High-risk Geographic Areas for Cardiac Arrest Using Three Methods for Cluster Analysis

Authors

  • Comilla Sasson MD, MS,

    1. From the Department of Emergency Medicine, University of Colorado School of Medicine (CS, AN, JSH), Aurora, CO; the Department of Emergency Medicine, The Ohio State University (MTC, MS, DK), Columbus, OH; the Department of Geography, Eastern Michigan University (HS), Ypsilanti, MI; the Institute for Healthcare Research, Kaiser Permanente (DJM), Denver, CO; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; and the Department of Emergency Medicine, Oregon Health and Sciences University (CRW), Portland, OR.
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  • Michael T. Cudnik MD, MPH,

    1. From the Department of Emergency Medicine, University of Colorado School of Medicine (CS, AN, JSH), Aurora, CO; the Department of Emergency Medicine, The Ohio State University (MTC, MS, DK), Columbus, OH; the Department of Geography, Eastern Michigan University (HS), Ypsilanti, MI; the Institute for Healthcare Research, Kaiser Permanente (DJM), Denver, CO; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; and the Department of Emergency Medicine, Oregon Health and Sciences University (CRW), Portland, OR.
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  • Ariann Nassel MS,

    1. From the Department of Emergency Medicine, University of Colorado School of Medicine (CS, AN, JSH), Aurora, CO; the Department of Emergency Medicine, The Ohio State University (MTC, MS, DK), Columbus, OH; the Department of Geography, Eastern Michigan University (HS), Ypsilanti, MI; the Institute for Healthcare Research, Kaiser Permanente (DJM), Denver, CO; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; and the Department of Emergency Medicine, Oregon Health and Sciences University (CRW), Portland, OR.
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  • Hugh Semple PhD,

    1. From the Department of Emergency Medicine, University of Colorado School of Medicine (CS, AN, JSH), Aurora, CO; the Department of Emergency Medicine, The Ohio State University (MTC, MS, DK), Columbus, OH; the Department of Geography, Eastern Michigan University (HS), Ypsilanti, MI; the Institute for Healthcare Research, Kaiser Permanente (DJM), Denver, CO; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; and the Department of Emergency Medicine, Oregon Health and Sciences University (CRW), Portland, OR.
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  • David J. Magid MD, MS,

    1. From the Department of Emergency Medicine, University of Colorado School of Medicine (CS, AN, JSH), Aurora, CO; the Department of Emergency Medicine, The Ohio State University (MTC, MS, DK), Columbus, OH; the Department of Geography, Eastern Michigan University (HS), Ypsilanti, MI; the Institute for Healthcare Research, Kaiser Permanente (DJM), Denver, CO; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; and the Department of Emergency Medicine, Oregon Health and Sciences University (CRW), Portland, OR.
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  • Michael Sayre MD,

    1. From the Department of Emergency Medicine, University of Colorado School of Medicine (CS, AN, JSH), Aurora, CO; the Department of Emergency Medicine, The Ohio State University (MTC, MS, DK), Columbus, OH; the Department of Geography, Eastern Michigan University (HS), Ypsilanti, MI; the Institute for Healthcare Research, Kaiser Permanente (DJM), Denver, CO; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; and the Department of Emergency Medicine, Oregon Health and Sciences University (CRW), Portland, OR.
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  • David Keseg MD,

    1. From the Department of Emergency Medicine, University of Colorado School of Medicine (CS, AN, JSH), Aurora, CO; the Department of Emergency Medicine, The Ohio State University (MTC, MS, DK), Columbus, OH; the Department of Geography, Eastern Michigan University (HS), Ypsilanti, MI; the Institute for Healthcare Research, Kaiser Permanente (DJM), Denver, CO; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; and the Department of Emergency Medicine, Oregon Health and Sciences University (CRW), Portland, OR.
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  • Jason S. Haukoos MD, MSc,

    1. From the Department of Emergency Medicine, University of Colorado School of Medicine (CS, AN, JSH), Aurora, CO; the Department of Emergency Medicine, The Ohio State University (MTC, MS, DK), Columbus, OH; the Department of Geography, Eastern Michigan University (HS), Ypsilanti, MI; the Institute for Healthcare Research, Kaiser Permanente (DJM), Denver, CO; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; and the Department of Emergency Medicine, Oregon Health and Sciences University (CRW), Portland, OR.
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  • Craig R. Warden MD, MPH, MS,

    1. From the Department of Emergency Medicine, University of Colorado School of Medicine (CS, AN, JSH), Aurora, CO; the Department of Emergency Medicine, The Ohio State University (MTC, MS, DK), Columbus, OH; the Department of Geography, Eastern Michigan University (HS), Ypsilanti, MI; the Institute for Healthcare Research, Kaiser Permanente (DJM), Denver, CO; the Department of Emergency Medicine, Denver Health Medical Center (JSH), Denver, CO; and the Department of Emergency Medicine, Oregon Health and Sciences University (CRW), Portland, OR.
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  • (The Columbus Study Group)


  • Presented at the American Heart Association Scientific Sessions, Chicago, IL, November 13–17, 2010.

  • The authors have no relevant financial information or potential conflicts of interest to disclose.

  • Supervising Editor: Clifton W. Callaway, MD, PhD.

and reprints: Comilla Sasson, MD, MS; e-mail: comilla.sasson@ucdenver.edu.

Abstract

ACADEMIC EMERGENCY MEDICINE 2012; 19:139–146 © 2012 by the Society for Academic Emergency Medicine

Abstract

Objectives:  The objective was to identify high-risk census tracts, defined as those areas that have both a high incidence of out-of-hospital cardiac arrest (OHCA) and a low prevalence of bystander cardiopulmonary resuscitation (CPR), by using three spatial statistical methods.

Methods:  This was a secondary analysis of two prospectively collected registries in the city of Columbus, Ohio. Consecutive adult (≥18 years) OHCA patients, restricted to those of cardiac etiology and treated by emergency medical services (EMS) from April 1, 2004, to April 30, 2009, were studied. Three different spatial analysis methods (Global Empirical Bayes, Local Moran’s I, and SaTScan’s spatial scan statistic) were used to identify high-risk census tracts.

Results:  A total of 4,553 arrests in 200 census tracts occurred during the study period, with 1,632 arrests included in the final sample after exclusions for no resuscitation attempt, noncardiac etiology, etc. The overall incidence for OHCA was 0.70 per 1,000 people for the 6-year study period (SD = ±0.52). Bystander CPR occurred in 20.2% (n = 329), with 10.0% (n = 167) surviving to hospital discharge. Five high-risk census tracts were identified by all three analytic methods.

Conclusions:  The five high-risk census tracts identified may be possible sites for high-yield targeted community-based interventions to improve CPR training and cardiovascular disease education efforts and ultimately improve survival from OHCA.

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