Pediatric Patients Discharged from the Emergency Department with Abnormal Vital Signs

Area of Science:

• Pediatric Emergency Medicine
• Clinical Quality Improvement

Background:

• Children frequently present to the emergency department (ED) with minor illnesses and may have abnormal vital signs upon discharge.
• Concerns exist regarding the safety of discharging pediatric patients with abnormal vital signs.

Purpose of the Study:

• To determine the proportion of children discharged from the ED with abnormal vital signs.
• To assess the frequency and nature of adverse events in this patient population.
• To compare adverse event rates between children discharged with normal versus abnormal vital signs.

Main Methods:

• Retrospective chart review of pediatric patients (2 months to 17 years) discharged from the ED over 44 months.
• Identification of patients with abnormal pulse rate, respiratory rate, temperature, or oxygen saturation.
• Utilized a quality assurance database to track post-discharge adverse events.

Main Results:

• 17% (5,540/33,185) of discharged children had at least one abnormal vital sign.
• Adverse events occurred in 0.43% of children with abnormal vital signs versus 0.17% with normal vital signs.
• Only one severe adverse event was potentially preventable by observation and related to the index visit.

Conclusions:

• Discharging pediatric patients with abnormal vital signs from the ED is common (17%) but associated with a low rate of adverse events (0.43%).
• Abnormal heart rate was the most frequent vital sign linked to adverse events.
• Severe adverse events potentially related to abnormal vital signs are exceedingly rare, warranting further research in diverse populations.