Intraosseous line use, complications, and outcomes among a population-based cohort of children presenting to California hospitals

Objectives: Intraosseous line (IO) use has been described in prehospital settings, with some studies in the emergency department (ED). However, population-based studies describing IO line use across diverse ED and hospital settings are sparse, and the true incidence of complications remains unknown. Methods: This was a retrospective cohort study using administrative data from 450 California hospitals and EDs. We included all children aged 0 to 18 years with ED or inpatient visits from 2005 through 2007. CPT (Current Procedural Terminology) and ICD-9 (International Classification of Diseases, Ninth Revision) codes were used to identify IO line use. ICD-9 diagnosis codes were searched for potential complications related to IO line use including compartment syndrome, fracture, and osteomyelitis. Descriptive statistics were used to calculate incidence of use, outcomes, and hospital setting with IO line use. Results: Two hundred ninety-one children had IO lines placed in 90 hospitals, including 239 in the ED and 52 inpatient. There were 6,660,564 pediatric ED visits and 2,276,231 pediatric admissions, resulting in an incidence of IO line placement of 0.04 per 1000 ED visits and 0.02 per 1000 admissions. Mortality was 37% among patients with IO line placement. The most common diagnoses included cardiac arrest (34%), trauma (19%), and respiratory failure (6%). Types of hospital in which IO lines were placed included children's hospitals 14%, general hospitals 86%, and rural hospitals 7.9%. No complications were identified. Conclusions: The overall incidence of IO line use in the ED and hospital setting is low, but IO line access is used in a variety of different hospital and ED settings for high-acuity conditions. No IO line complications were identified.