Risk of in-hospital Deterioration for Children with Single Ventricle Physiology

Area of Science:

• Pediatric Cardiology
• Critical Care Medicine
• Health Informatics

Background:

• Children with single ventricle (SV) physiology are at significant risk for in-hospital complications, including morbidity and mortality.
• Early identification of children at risk for clinical deterioration is crucial for timely intervention and improved survival rates.

Purpose of the Study:

• To identify risk factors and predictors of clinical deterioration in infants with single ventricle physiology.
• To evaluate the utility of electronic health record data for early detection of deterioration in this population.

Main Methods:

• Retrospective chart review of pediatric cardiology non-ICU admissions from 2014-2018 for children under 18.
• Definition of clinical deterioration as unplanned ICU transfer or inpatient mortality.
• Comparison of demographic, vital sign, and laboratory values between infants with and without deterioration events, including analysis of changes preceding deterioration.

Main Results:

• Infants with SV who deteriorated were younger, with lower baseline oxygen saturation and higher baseline respiratory rate, heart rate, and hematocrit.
• The Duke Pediatric Early Warning Score significantly increased prior to deterioration events.
• Deterioration was associated with increased need for oxygen support, fluid boluses, antibiotics, vasopressors, and red blood cell transfusions.

Conclusions:

• Infants with single ventricle physiology exhibit a high risk of clinical deterioration during hospitalization.
• Integrating baseline and dynamic patient data from the electronic health record is essential for identifying high-risk patients.
• Earlier detection and intervention strategies informed by EHR data can potentially prevent clinical deterioration and reduce mortality in infants with SV.