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Editor's Correspondence |

It Is Time to Get More Accurate Times to Defibrillation

John A. Stewart, RN, MA
Arch Intern Med. 2009;169(22):2162-2166. doi:10.1001/archinternmed.2009.451.
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The recent article by Chan et al1 finds wide variations in the incidence of delayed defibrillation among hospitals that are not adequately explained by hospital-level factors. The authors assume that these variations represent real differences in hospital performance and call for efforts to identify the approaches of top-performing hospitals so that other facilities may adopt them.

Though the authors' attention to this problem is welcome, using the reported data to identify and emulate hospitals achieving “best practices” is likely to be a waste of time and effort. The problem is that the study was based on the time-interval data from the National Registry of Cardiopulmonary Resuscitation (NRCPR). The NRCPR's time-interval data come from handwritten code records and are rounded to the nearest minute, resulting in clearly invalid aggregate statistics: median times to first defibrillation of 0 minutes2 or 1 minute1 and first quartiles of 0 minutes.1,2 These figures are clearly impossible, representing not only inaccuracy but gross underestimation of the problem of delayed defibrillation. Though the analysis of survival by quartiles indicates that the NRCPR data are not completely random, I believe that more accurate data are both desirable and achievable.

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