Emergency Transfers: An Important Predictor of Adverse Outcomes in Hospitalized Children

Area of Science:

• Pediatric critical care medicine
• Hospital quality improvement
• Patient safety

Background:

• In-hospital arrests in children are rare, complicating risk identification for unrecognized deterioration.
• Rapid response systems aim to prevent critical events, but their effectiveness, particularly concerning emergency transfers (ETs), requires validation.
• Improvement science has focused on reducing ETs, but their predictive value for patient outcomes remains underexplored.

Purpose of the Study:

• To assess the predictive validity of emergency transfers (ETs) for adverse health outcomes in a pediatric hospital.
• To determine if ETs are associated with increased mortality and longer hospital stays.
• To validate the clinical significance of ETs as an indicator of patient instability.

Main Methods:

• A case-control study was conducted at a free-standing children's hospital.
• Emergency transfers (ETs) were defined as transfers to the intensive care unit (ICU) involving intubation, inotropes, or ≥3 fluid boluses within the first hour.
• Controls were matched to ET cases based on age, hospital unit, and time of year.

Main Results:

• Patients experiencing an ET had a significantly higher likelihood of in-hospital mortality (22% vs. 9%).
• Emergency transfers were associated with substantially longer ICU length of stay (4.9 vs. 2.2 days).
• Post-transfer length of stay was also significantly longer for patients who underwent an ET (26.4 vs. 14.7 days).

Conclusions:

• Emergency transfers (ETs) are strong predictors of adverse outcomes in pediatric patients.
• The findings validate the clinical significance of ETs, indicating severe patient instability.
• These results underscore the importance of early recognition and intervention to prevent critical deterioration requiring an ET.