{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T19:22:52Z","timestamp":1772479372258,"version":"3.50.1"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fundamental Fund, Khon Kaen University, Thailand","award":["FF2569"],"award-info":[{"award-number":["FF2569"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pediatric in-hospital cardiac arrest (IHCA) is frequently fatal, and evidence from middle-income settings needed to guide quality improvement is sparse. We used nationwide Thai data to quantify incidence and mortality trends, describe long-term outcomes, and identify associated factors for post-discharge death after pediatric IHCA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective cohort study using the Thai National Health Security Office database encompassing all hospitalizations under the universal health-coverage scheme from 1 January 2015\u201331 December 2022. Children &lt;18 years with IHCA were identified by ICD-10-TM codes I46.0\/I46.1\/I46.9 plus at least one resuscitation procedure code (ICD-9-CM 99.60\/99.62\/99.63). All-cause mortality through 31 December 2023 was obtained via linkage to the national civil registry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 13.2 million pediatric admissions, 20,590 IHCAs were recorded (incidence 1.57\/1,000). Incidence declined from 1.8\/1,000 in 2015\u20132016 to 1.2\/1,000 in 2022. In-hospital mortality was 62.7% (12,905\/20,590). Of 7,253 survivors with follow-up (median 67 months), 2,149 (29.6%) died post-discharge. Multivariable analysis identified metabolic acidosis (adjusted hazard ratio [aHR] 1.50; 95% confidence interval [CI] 1.32\u20131.71) and hypoglycemia (aHR 1.54; 95% CI 1.25\u20131.89) as significant associated diagnoses with long-term mortality. Furthermore, diagnoses consistent with severe organ dysfunction, including disseminated intravascular coagulation (aHR 1.51; 95% CI 1.24\u20131.85), acute liver failure (aHR 1.42; 95% CI 1.10\u20131.84), and anoxic brain injury (aHR 1.23; 95% CI 1.05\u20131.44), were also significantly correlated with increased mortality; however, the timing of these diagnoses relative to the cardiac arrest could not be determined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pediatric IHCA in Thailand remains highly fatal despite recent declines in incidence and in-hospital mortality. During a median follow-up of 67 months, nearly one-third of survivors died after discharge, underscoring the substantial long-term mortality burden. Metabolic derangements and organ dysfunction were strongly associated with post-discharge mortality, highlighting the need for targeted strategies to improve both survival and long-term outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0341430","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T18:21:54Z","timestamp":1772475714000},"page":"e0341430","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with survival after pediatric in-hospital cardiac arrest: A national database analysis 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Slatnick","year":"2020","journal-title":"J Pediatr"},{"key":"pone.0341430.ref026","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.resuscitation.2015.02.005","article-title":"Patterns of multiorgan dysfunction after pediatric drowning","volume":"90","author":"H Mtaweh","year":"2015","journal-title":"Resuscitation"},{"issue":"4","key":"pone.0341430.ref027","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/PCC.0000000000001091","article-title":"Multiple Organ Dysfunction in Children Mechanically Ventilated for Acute Respiratory Failure","volume":"18","author":"SL Weiss","year":"2017","journal-title":"Pediatr Crit Care Med"},{"issue":"5","key":"pone.0341430.ref028","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1097\/PCC.0b013e3181a64be1","article-title":"Day 1 multiple organ dysfunction syndrome is associated with poor functional outcome and mortality in the pediatric intensive care unit","volume":"10","author":"KV Typpo","year":"2009","journal-title":"Pediatr Crit Care Med"},{"issue":"8","key":"pone.0341430.ref029","doi-asserted-by":"crossref","DOI":"10.1097\/PCC.0b013e3182976402","article-title":"Early lactate elevations following resuscitation from pediatric cardiac arrest are associated with increased mortality*","volume":"14","author":"AA Topjian","year":"2013","journal-title":"Pediatr Crit Care Med"},{"issue":"12","key":"pone.0341430.ref030","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1002\/glia.20440","article-title":"Hypoglycemia, brain energetics, and hypoglycemic neuronal death","volume":"55","author":"SW Suh","year":"2007","journal-title":"Glia"},{"issue":"3","key":"pone.0341430.ref031","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.resuscitation.2004.06.008","article-title":"Characteristics and outcome of cardiorespiratory arrest in children","volume":"63","author":"J 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