Repeat Rapid Response Events in Children: Characteristics and Outcomes

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.