Vital Sign and Nursing Assessment Patterns in Emergency Transfers to the Intensive Care Unit

Pediatric patients requiring emergency transfer (ET) to an intensive care unit (ICU) have higher in-hospital morbidity and mortality. Understanding clinical indicators preceding transfer in those requiring emergent intervention can inform the development of tools focused on early recognition of clinical deterioration.

To evaluate patterns of clinical deterioration in vital sign and nursing assessment data before ET vs non-ET to the ICU from acute care units.

A single-center retrospective case-cohort study was conducted at a quaternary pediatric hospital of patients requiring ET (n = 78) vs non-ET (n = 166) from acute care units to an ICU between 2015 and 2018. Exposure variables included vital sign and nursing assessment data at time of and 4-, 8-, 12-, and 16 hours before transfer. Groups were compared by Wilcoxon rank sum or chi-square tests. Analysis of covariance modeling compared longitudinal trajectories of vital signs after adjusting for sex, age, and primary service.

Patients requiring ET had significantly lower mean arterial pressures at time of and 8 hours before transfer. No differences in heart or respiratory rate were detected between groups. Nursing assessment data showed prolonged capillary refill in the ET group starting 12 hours preceding transfer and persisting until transfer.

Patients requiring ET displayed clinical evidence of hypoperfusion before transfer without significantly higher heart rates. These findings suggest that tachycardia alone may not be a reliable indicator of impending ET vs non-ET and emphasize the importance of incorporating both objective and subjective data into situation-awareness tools.