Repeat Rapid Response Events in Children: Characteristics and Outcomes
Kristen M Meulmester1, Nancy Jaimon1, Aarti C Bavare2
1Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Insights
Pediatric repeat rapid response events indicate high medical complexity and worse outcomes, with similar triggers to initial events. These events are linked to increased intensive care unit transfers and higher mortality rates.
Area of Science:
- Pediatric critical care medicine
- Hospital patient safety
- Clinical outcomes research
Background:
- Repeat rapid response events in pediatric hospitalizations are not well understood.
- Understanding these events is crucial for improving patient safety and outcomes in complex pediatric cases.
Purpose of the Study:
- To characterize the features and outcomes of pediatric repeat rapid response events within a single hospitalization.
- To test the hypothesis that triggers for repeat rapid response events are similar to initial events and that repeat events are associated with increased medical complexity and poorer outcomes.
Main Methods:
- A 3-year retrospective study was conducted at a high-volume tertiary academic pediatric hospital.
- All rapid response events were reviewed to identify initial and repeat events, analyzing patient demographics, triggers, diagnoses, interventions, ICU transfers, deterioration, and mortality.
Main Results:
- 146 patients experienced 309 rapid response events (163 repeat events). 85% of repeat events occurred in medically complex patients.
- Triggers for repeat rapid response events (71%) matched initial events. ICU transfer was significantly higher after repeat events (76%) vs. initial events (47%).
- Repeat rapid response events were associated with longer hospital stays and a 14% mortality rate, primarily in medically complex patients, which is higher than overall rapid response mortality.
Conclusions:
- Repeat rapid response events in pediatric patients are strongly associated with medical complexity and predict worse outcomes.
- The triggers for initial and repeat rapid response events are similar, suggesting a need for proactive management of complex patients.
- Increased ICU transfers, longer hospital stays, and higher mortality highlight the critical nature of repeat rapid response events in pediatric care.
Objective:
We describe the characteristics and outcomes of pediatric repeat rapid response events within a single hospitalization. We hypothesized that triggers for repeat rapid response and initial rapid response events are similar, and repeat rapid response events are associated with high prevalence of medical complexity and worse outcomes.
Design:
A 3-year retrospective study.
Setting:
High-volume tertiary academic pediatric hospital.
Patients:
All rapid response events were reviewed to identify repeat rapid response events.
Intervention:
None.
Measurements And Main Results:
Patient demographics, rapid response triggers, primary clinical diagnoses, illness acuity scores, medical interventions, transfers to ICU, occurrence of critical deterioration, and mortality were reviewed. We reviewed 146 patients with 309 rapid response events (146 initial rapid response and 163 repeat rapid response: 36% < 24 hr, 38% 24 hr to 7 d, and 26% > 7 d after initial rapid response). Median age was 3 years, and 60% were males. Eighty-five percentage of repeat rapid response occurred in medical complexity patients. The triggers for 71% of all repeat rapid response matched with those of initial rapid response. Transfer to ICU occurred in 69 (47%) of initial rapid response and 124 (76%) of repeat rapid response (p < 0.01). The median hospital stay was 11 and 30 days for previously healthy and medical complexity patients, respectively (p = 0.16). ICU readmission at repeat rapid response was associated with longer hospital stay (p < 0.01). Mortality during hospitalization occurred in 14% (all medically complex) of patients after repeat rapid response. Hospital mortality after rapid response is 4.4% per our center's administrative data and 6.7% according to published multicenter data.
Conclusions:
Prevalence of medical complexity was high in patients with repeat rapid response compared with that reported for pediatric hospitalizations. Triggers between initial and repeat rapid response events correlated. Transfer to ICU was more likely after repeat rapid response and among repeat rapid response, events with ICU readmissions had a longer length of ICU and hospital stay. Mortality for the repeat rapid response cohort was higher than that for overall rapid responses in our center and per published reports from other centers.
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