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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Characteristics of Children Who Deteriorate After Transport and Associated Preadmission Factors
Cara A Cecil1, Z Leah Harris1, L Nelson Sanchez-Pinto1
1Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School Medicine, Chicago, IL.
Insights
Pediatric deterioration occurred in 7% of children admitted to general units, particularly those with respiratory issues. Transport teams should monitor children with respiratory disease or complex conditions closely.
Area of Science:
- Pediatric Medicine
- Hospital Medicine
- Patient Safety
Background:
- The incidence and risk factors for deterioration in children transferred from emergency departments (EDs) to general inpatient units are not well-established.
- Understanding these factors is crucial for improving care and patient outcomes.
Purpose of the Study:
- To describe the population of children transferred from EDs to general inpatient units.
- To identify pre-admission characteristics associated with patient deterioration.
Main Methods:
- A single-center cohort study included children (≤ 18 years) admitted from EDs between 2016 and 2019.
- Deterioration was defined as rapid response team activation, ICU transfer, or cardiac/respiratory arrest within 24 hours of admission.
- Logistic regression analysis was used to identify associated factors.
Main Results:
- Deterioration occurred in 6.8% of 1,988 included children, with higher rates in those with respiratory diagnoses (10.1%).
- Factors associated with deterioration included ≥ 2 complex chronic conditions (aOR=2.09) and longer stabilization times.
- ICU transfer was linked to complex chronic conditions, nasal cannula oxygen, and nebulizer treatments.
Conclusions:
- Approximately 7% of pediatric patients admitted to general units experienced deterioration, predominantly those with respiratory complaints.
- Children with respiratory disease, multiple complex chronic conditions, or requiring specific respiratory support (nasal cannula, nebulizer) are at increased risk.
- The clinical significance of slightly longer stabilization times requires further investigation.
Objective:
The incidence of deterioration and associated characteristics are largely unknown for children transported for admission from referring emergency departments (EDs) to general inpatient units. This study describes this population and identifies associated preadmission characteristics.
Methods:
This single-center cohort study included children ≤ 18 years old transferred from an ED and directly admitted to general inpatient units from 2016 to 2019. Deterioration was defined as 1 or more of the following occurring within 24 hours of admission: rapid response team activation, transfer to the intensive care unit (ICU), or cardiac or respiratory arrest. ICU transfer was the secondary outcome. Logistic regression was performed.
Results:
One thousand nine hundred eighty-eight patients were included; the median age was 4.2 years, 53.9% were male, and 44.1% had respiratory diagnoses. Deterioration occurred in 135 (6.8%) children overall and in 10.1% of children with respiratory complaints. Deterioration was associated with ≥ 2 complex chronic conditions (adjusted odds ratio [aOR] = 2.09; 95% confidence interval [CI], 1.04-4.19) and a longer stabilization time (per 10 minutes) (aOR = 1.17; 95% CI, 1.01-1.36). ICU transfer was associated with ≥ 2 complex chronic conditions (aOR = 2.33; 95% CI, 1.13-4.80), supplemental oxygen via nasal cannula (aOR = 2.13; 95% CI, 1.18-3.85), and nebulizer treatment (aOR = 2.77; 95% CI, 1.21-6.35).
Conclusion:
Deterioration was experienced by 7% of children admitted to a general unit, with the majority having respiratory complaints. Transport teams should consider the potential for increased risk of deterioration among children with respiratory disease, multiple complex chronic conditions, and a nasal cannula or nebulizer therapy. The clinical significance of marginally longer stabilization times is unclear and warrants further investigation.
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