Children with single ventricle physiology (SV) are at high risk of in-hospital morbidity and mortality. Identifying children at risk for deterioration may allow for earlier escalation of care and subsequently decreased mortality. We conducted a retrospective chart review of all admissions to the pediatric cardiology non-ICU service from 2014–2018 for children < 18 years old. We defined clinical deterioration as unplanned transfer to the ICU or inpatient mortality. We selected children with SV by diagnosis codes and defined infants as children < 1 year old. We compared demographic, vital sign, and lab values between infants with and without a deterioration event. We evaluated vital sign and medical therapy changes before deterioration events. Among infants with SV (129 deterioration events over 225 admissions, overall 25% with hypoplastic left heart syndrome), those who deteriorated were younger (p = 0.001), had lower baseline oxygen saturation (p = 0.022), and higher baseline respiratory rate (p = 0.022), heart rate (p = 0.023), and hematocrit (p = 0.008). Median Duke Pediatric Early Warning Score increased prior to deterioration (p < 0.001). Deterioration was associated with administration of additional oxygen support (p = 0.012), a fluid bolus (p < 0.001), antibiotics (p < 0.001), vasopressor support (p = 0.009), and red blood cell transfusion (p < 0.001). Infants with SV are at high risk for deterioration. Integrating baseline and dynamic patient data from the electronic health record to identify the highest risk patients may allow for earlier detection and intervention to prevent clinical deterioration.

Introduction: Stage 1 single ventricle palliation has the longest associated length of stay (LOS) of STS benchmark operations. Patient level factors that contribute to prolonged hospitalization have been identified, but center level factors have not been explored. We aim to identify center level factors that drive post-Stage 1 palliation LOS. Methods: We analyzed data prospectively collected by the National Pediatric Cardiology Quality Improvement Collaborative Phase II registry. We included all infants who underwent stage 1 followed by either stage 2 or death. We excluded centers with fewer than 10 cases and centers or patients with missing key variables. Our primary outcome was center level LOS. We grouped centers into quartiles based on median LOS for all patients at each center and compared patient and center level characteristics between highest and lowest performing quartiles using univariable analyses. Results: Of 2510 infants (65 sites), 1831 (30 sites) met study criteria (61% male, 61% white, 17% premature, 73% with hypoplastic left heart as primary cardiac diagnosis). There was wide inter-center variation in LOS (1st quartile centers: median 28 days [IQR 19, 47]; 4th quartile: 62 days [35, 96], p<0.001). Shorter LOS correlated with more outside hospital days alive prior to stage 2, after accounting for readmissions (correlation coefficient -0.49, p<0.001). Compared to 7 low performing centers, 8 high performing centers were more likely to perform the Norwood with an RV-PA conduit (64% v 48%, p<0.001), extubate patients earlier (10 days [7, 15] v 14 days [11, 25], p<0.001), start enteral feeds sooner (9 days [7, 13] v 13 days [10, 22], p<0.001), and were more likely to discharge patients on nasogastric feeds (57% v 19%, p<0.001) vs G-tube feeds (7% v 41%, p<0.001) (Table 1). Conclusions: There was significant inter-center variation in post-Stage 1 LOS. Modifiable center-level practices may be targets to standardize practice and reduce overall LOS across centers.

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Children with single ventricle physiology (SV) are at high risk of in-hospital morbidity and mortality.Identifying children at risk for deterioration may allow for earlier escalation of care and subsequently decreased mortality.We conducted a retrospective chart review of all admissions to the pediatric cardiology non-ICU service from 2014-2018 for children < 18 years old. We de ned clinical deterioration as unplanned transfer to the ICU or inpatient mortality. We selected children with SV by diagnosis codes and de ned infants as children < 1 year old. We compared demographic, vital sign, and lab values between infants with and without a deterioration event. We evaluated vital sign and medical therapy changes before deterioration events.Among infants with SV (129 deterioration events over 225 admissions, overall 25% with hypoplastic left heart syndrome), those who deteriorated were younger (p = 0.001), had lower baseline oxygen saturation (p = 0.022), and higher baseline respiratory rate (p = 0.022), heart rate (p = 0.023), and hematocrit (p = 0.008). Median Duke Pediatric Early Warning Score increased prior to deterioration (p < 0.001).Deterioration was associated with administration of additional oxygen support (p = 0.012), a uid bolus (p < 0.001), antibiotics (p < 0.001), vasopressor support (p = 0.009), and red blood cell transfusion (p < 0.001).Infants with SV are at high risk for deterioration. Integrating baseline and dynamic patient data from the electronic health record to identify the highest risk patients may allow for earlier detection and intervention to prevent clinical deterioration.