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Published on: January 17, 2011
Characteristics and Outcomes of Pediatric Rapid Response With a Respiratory Trigger
Kristen M Meulmester1, Jorge A Coss-Bu2, Sarah D Meskill3
1Sections of Critical Care Medicine kristen.meulmester@gmail.com.
Insights
Pediatric rapid response events with respiratory triggers show better outcomes for patients with respiratory diagnoses. Complex chronic conditions increase risks, highlighting the importance of diagnosis in pediatric rapid response care.
Area of Science:
- Pediatric critical care medicine
- Hospital patient safety
- Clinical outcomes research
Background:
- Rapid response teams (RRTs) improve adult patient outcomes, but pediatric RRT trigger associations are understudied.
- Pediatric rapid response with a respiratory trigger (Resp-RRT) characteristics and outcomes require further investigation.
Purpose of the Study:
- To explore the characteristics and outcomes of pediatric Resp-RRTs.
- To determine if patient outcomes vary based on primary diagnosis during Resp-RRT.
Main Methods:
- A 2-year retrospective observational study was conducted.
- Data were collected from an academic tertiary care pediatric hospital.
Main Results:
- Patients with respiratory diagnoses (N=686) in Resp-RRTs were younger and had fewer complex chronic conditions than those with nonrespiratory diagnoses (N=601).
- Respiratory diagnosis was associated with increased noninvasive ventilation use, decreased vasoactive support, and lower 30-day mortality.
- Acute respiratory illness patients had better outcomes than acute-on-chronic respiratory illness patients.
Conclusions:
- Pediatric Resp-RRTs with respiratory diagnoses are linked to better long-term outcomes despite increased ICU respiratory support.
- Complex chronic conditions elevate the risk of acute respiratory support and mortality in pediatric Resp-RRTs.
- Understanding the interplay between primary diagnosis and RRT triggers can optimize resource allocation and predict outcomes for pediatric Resp-RRTs.
Background And Objectives:
Authors of adult rapid response (RRT) studies have established that RRT triggers play an important role in outcomes, but this association is not studied in pediatrics. In this study, we explore the characteristics and outcomes of pediatric rapid response with a respiratory trigger (Resp-RRT). We hypothesize that outcomes differ on the basis of patients' primary diagnoses at the time of Resp-RRT.
Methods:
We conducted a 2-year retrospective observational study at an academic tertiary care pediatric hospital.
Results:
Among the 1287 Resp-RRTs in 1060 patients, those with a respiratory diagnosis (N = 686) were younger, less likely to have complex chronic conditions, and less likely to have concurrent triggers (P < .01) than those with a nonrespiratory diagnosis (N = 601). Patients with a respiratory diagnosis were more likely to receive noninvasive ventilation, less likely to receive vasoactive support, and had lower 30-day mortality (P < .01). Among those with a respiratory diagnosis, the 541 patients with acute illness were younger, less likely to have complex chronic conditions, and less likely to receive vasoactive support than those with acute on chronic illness (N = 100) (P < .01).
Conclusions:
Among pediatric respiratory-triggered RRT events, patients with a respiratory diagnosis were more likely to receive acute respiratory support in ICU but have better long-term outcomes. Presence of complex chronic conditions increases risk of acute respiratory support and mortality. The interplay of primary diagnosis with RRT trigger can potentially inform resource needs and outcomes for pediatric Resp-RRTs.
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