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Routine Overnight Assessments in Stable Pediatric Surgery Patients: A Critical Reconsideration
Morgan Brown1, Rebecca Moreci1, Hannah Megison2
1Louisiana State University Health Sciences Center, Department of Surgery, 2021 Perdido St, New Orleans, LA, 70112, USA; Our Lady of the Lake Children's Health, Division of Pediatric Surgery, 8300 Constantin Blvd, Baton Rouge, LA, 70809, USA.
Insights
Overnight vital sign monitoring in pediatric surgery patients rarely leads to interventions, despite frequent abnormalities. Prioritizing patient safety with routine assessments remains crucial until specific patient groups can be identified for reduced monitoring.
Area of Science:
- Pediatric Surgery
- Critical Care Medicine
- Sleep Medicine
Background:
- Overnight vital sign (OVS) monitoring disrupts sleep in hospitalized patients, potentially causing adverse outcomes.
- Previous studies suggest OVS checks infrequently detect significant events in pediatric populations.
- This study investigates the utility of OVS monitoring in pediatric surgery patients.
Purpose of the Study:
- To determine the frequency of abnormal OVS in pediatric surgery patients.
- To assess the rate of interventions resulting from abnormal OVS.
- To evaluate the clinical significance of OVS findings in this cohort.
Main Methods:
- Retrospective chart review of 354 pediatric surgery patients (ages 5-19) from 2019-2021.
- Exclusion of Intensive Care Unit (ICU) patients.
- Analysis of OVS recorded between 10:00 PM and 6:00 AM and subsequent interventions.
Main Results:
- 62% of patients exhibited at least one abnormal OVS, most commonly abnormal blood pressure (80%).
- Interventions were recorded for 58% of flagged OVS, primarily medication administration (54%).
- Unplanned operative interventions (0.9%) and ICU transfers (1.4%) were infrequent but occurred.
Conclusions:
- While most pediatric surgery patients have abnormal OVS, significant interventions are rare.
- Routine vital sign assessments are supported for patient safety.
- Further research is needed to identify patient subgroups who could benefit from reduced sleep disruption.
Background:
Hospitalized patients are subject to overnight vital sign (OVS) monitoring which leads to subsequent sleep disturbance and contributes to adverse outcomes and negative hospital experiences. Studies in pediatric populations have shown that routine OVS checks infrequently detect significant events. We hypothesized that OVS monitoring in pediatric surgery patients rarely detects abnormalities resulting in meaningful interventions.
Materials And Methods:
We performed a retrospective chart review of patients ≥ 5 years old admitted to the pediatric surgery service at a stand-alone Children's Hospital from 2019 to 2021. ICU patients were excluded from analysis. Overnight vital signs were defined as those recorded every 4 h between 10:00 PM and 6:00 AM. Abnormal OVS and subsequent interventions were recorded.
Results:
Analysis included 354 patients aged 5-19 years old. At least one OVS was abnormal in 62% of patients. Abnormal blood pressure was the most commonly flagged OVS (80%). The rate of intervention for flagged OVS was 58%. Medication administration was the most common intervention (54%). Unplanned operative intervention and transfer to the ICU were uncommon but did occur in this cohort (0.9% and 1.4%, respectively).
Conclusion:
The majority of pediatric surgery patients had at least one flagged OVS and, while rare, some serious complications were detected. While minimizing sleep disturbance and maximizing patient satisfaction is valuable, these results support prioritizing patient safety with routine vital sign assessments until we can determine if there are sub-populations that can be safely managed without sleep disruptions.
Level Of Evidence:
Level 4.
Study Type:
Retrospective chart review.
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