Association of Hospitalization-Level Characteristics With Pediatric Rapid Response Team Outcomes

Many institutions have implemented rapid response teams (RRTs) to assess deteriorating patients. Acute deterioration events are often used as proxies for mortality in children; however, risk factors for decompensation events are not well defined.

We identified all RRT events for pediatric admissions from January 2019 through June 2024 at a quaternary care hospital. Our primary outcome was acute deterioration within 6 hours of the RRT event, which included intubation or vasoactive medication use. We also report the rate of transfer to an intensive care unit (ICU). We compared patient and hospitalization-level characteristics among those with vs without an acute deterioration event. Finally, we used logistic regression to identify risk factors associated with acute deterioration including age, sex, medical complexity, respiratory support at the time of RRT, and primary service at the time of RRT.

We identified 2797 RRTs, of which 212 (7.6%) resulted in an acute deterioration event within 6 hours; 1545 (55%) RRT events resulted in transfer to an ICU. In multivariable logistic regression models accounting for age, sex, patient medical complexity, primary service, and respiratory support, respiratory support at the time of RRT and patient medical complexity were independently associated with an acute deterioration event. Specifically, high-flow nasal cannula at the time of RRT event was associated with lower odds of acute deterioration (odds ratio, 0.50; 95% CI, 0.32-0.79) and complex chronic conditions were associated with higher odds of acute deterioration (odds ratio, 3.11; 95% CI, 1.43-6.80).

Hospitalization-level characteristics may be used to assess the role of institutional pediatric RRT systems in preventing acute deterioration events, predicting escalations in care, and informing RRT resource allocation and improvement efforts.