Emergency Transfers: An Important Predictor of Adverse Outcomes in Hospitalized Children

Hussain, Farah; Sosa, Tina; Ambroggio, Lilliam; Gallagher, Regan; Brady, Patrick

doi:10.12788/jhm.3219

“…CDEs, which are likely more sensitive, may be useful in settings in which deterioration is rare or a more common outcome enhances power to detect the effect of interventions. 10 This study has limitations and lends itself to future work. While CDEs and ETs are more common than cardiopulmonary arrest, they remain relatively uncommon.…”

Section: Discussionmentioning

confidence: 95%

“…9 Recently, ETs were associated with an increased in-hospital mortality, ICU length of stay, and post-transfer hospital length of stay when compared with nonemergent transfers. 10,11 While both CDEs and ETs were associated with adverse outcomes in children and may be modifiable through better rapid response systems, researchers have not previously compared the extent to which CDEs and ETs capture similar versus distinct events. Furthermore, the ability of focused situation awareness interventions to identify high-risk patients has not previously been assessed.…”

mentioning

confidence: 99%

Comparing Two Proximal Measures of Unrecognized Clinical Deterioration in Children

Sosa

¹

,

Ferris

²

,

Frese

³

et al. 2020

Journal of Hospital Medicine

Self Cite

View full text Add to dashboard Cite

Critical deterioration events (CDEs) and emergency transfers (ETs) are two proximal measures to cardiopulmonary arrest, and both aim to evaluate how systems recognize and respond to clinical deterioration in children. This retrospective observational study sought to (1) characterize CDEs and ETs by timing, overlap, and intervention category, and (2) evaluate the performance of the watcher identification system and the pediatric early warning score (PEWS) to identify patients who experience these events. A total of 359 CDEs and 88 ETs occurred during the study period. Respiratory events were most common and accounted for 80.5% of CDEs and 47.7% of ETs. A narrow majority of patients were identified as watchers (55.4% of CDEs and 51.1% of ETs). In total, 85.5% of CDEs and 87.5% of ETs were identified as watchers, elevated PEWS, or both. Opportunities exist for improved escalation plans for high-risk patients to prevent the need for emergent intervention.

show abstract

“…Events of clinical deterioration leading to emergent pediatric intensive care unit (PICU) transfer can have dire consequences for children [1,2]. Children who have events of clinical deterioration while on the acute care floor can have a 13-fold increased risk of hospital mortality; increased morbidity, and longer ICU and overall hospital lengths of stay (LOS) [1,[3][4][5]. Current approaches to identify children at risk for clinical deterioration on the acute care floor include the use of early warning scoring systems, such as the Pediatric Early Warning Score (PEWS), to offer a "triggering" threshold based on physiological severity of illness parameters leading to escalations in care or the use of rapid response teams [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…Events of clinical deterioration leading to emergent pediatric intensive care unit (PICU) transfer can have dire consequences for children [ 1 , 2 ]. Children who have events of clinical deterioration while on the acute care floor can have a 13-fold increased risk of hospital mortality; increased morbidity, and longer ICU and overall hospital lengths of stay (LOS) [ 1 , 3 - 5 ].…”

Section: Introductionmentioning

confidence: 99%

Accuracy and Monitoring of Pediatric Early Warning Score (PEWS) Scores Prior to Emergent Pediatric Intensive Care Unit (ICU) Transfer: Retrospective Analysis

Kowalski

¹

,

Lee

²

,

Spaeder

³

et al. 2021

JMIR Pediatr Parent

View full text Add to dashboard Cite

Background Current approaches to early detection of clinical deterioration in children have relied on intermittent track-and-trigger warning scores such as the Pediatric Early Warning Score (PEWS) that rely on periodic assessment and vital sign entry. There are limited data on the utility of these scores prior to events of decompensation leading to pediatric intensive care unit (PICU) transfer. Objective The purpose of our study was to determine the accuracy of recorded PEWS scores, assess clinical reasons for transfer, and describe the monitoring practices prior to PICU transfer involving acute decompensation. Methods We conducted a retrospective cohort study of patients ≤21 years of age transferred emergently from the acute care pediatric floor to the PICU due to clinical deterioration over an 8-year period. Clinical charts were abstracted to (1) determine the clinical reason for transfer, (2) quantify the frequency of physiological monitoring prior to transfer, and (3) assess the timing and accuracy of the PEWS scores 24 hours prior to transfer. Results During the 8-year period, 72 children and adolescents had an emergent PICU transfer due to clinical deterioration, most often due to acute respiratory distress. Only 35% (25/72) of the sample was on continuous telemetry or pulse oximetry monitoring prior to the transfer event, and 47% (34/72) had at least one incorrectly documented PEWS score in the 24 hours prior to the event, with a score underreporting the actual severity of illness. Conclusions This analysis provides support for the routine assessment of clinical deterioration and advocates for more research focused on the use and utility of continuous cardiorespiratory monitoring for patients at risk for emergent transfer.

show abstract

“…Events of clinical deterioration leading to emergent pediatric intensive care unit (PICU) transfer can have dire consequences for children [1,2]. Children who have events of clinical deterioration while on the acute care floor can have a 13-fold increased risk of hospital mortality; increased morbidity, and longer ICU and overall hospital lengths of stay (LOS) [1,[3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Accuracy and Monitoring of Pediatric Early Warning Score (PEWS) Scores Prior to Emergent Pediatric Intensive Care Unit (ICU) Transfer: Retrospective Analysis (Preprint)

Kowalski¹,

Lee²,

Spaeder³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

BACKGROUND Current approaches to early detection of clinical deterioration in children have relied on intermittent track-and-trigger warning scores such as the Pediatric Early Warning Score (PEWS) that rely on periodic assessment and vital sign entry. There are limited data on the utility of these scores prior to events of decompensation leading to pediatric intensive care unit (PICU) transfer. OBJECTIVE The purpose of our study was to determine the accuracy of recorded PEWS scores, assess clinical reasons for transfer, and describe the monitoring practices prior to PICU transfer involving acute decompensation. METHODS We conducted a retrospective cohort study of patients ≤21 years of age transferred emergently from the acute care pediatric floor to the PICU due to clinical deterioration over an 8-year period. Clinical charts were abstracted to (1) determine the clinical reason for transfer, (2) quantify the frequency of physiological monitoring prior to transfer, and (3) assess the timing and accuracy of the PEWS scores 24 hours prior to transfer. RESULTS During the 8-year period, 72 children and adolescents had an emergent PICU transfer due to clinical deterioration, most often due to acute respiratory distress. Only 35% (25/72) of the sample was on continuous telemetry or pulse oximetry monitoring prior to the transfer event, and 47% (34/72) had at least one incorrectly documented PEWS score in the 24 hours prior to the event, with a score underreporting the actual severity of illness. CONCLUSIONS This analysis provides support for the routine assessment of clinical deterioration and advocates for more research focused on the use and utility of continuous cardiorespiratory monitoring for patients at risk for emergent transfer.

show abstract

Emergency Transfers: An Important Predictor of Adverse Outcomes in Hospitalized Children

Cited by 33 publications

References 21 publications

Comparing Two Proximal Measures of Unrecognized Clinical Deterioration in Children

Comparing Two Proximal Measures of Unrecognized Clinical Deterioration in Children

Accuracy and Monitoring of Pediatric Early Warning Score (PEWS) Scores Prior to Emergent Pediatric Intensive Care Unit (ICU) Transfer: Retrospective Analysis

Accuracy and Monitoring of Pediatric Early Warning Score (PEWS) Scores Prior to Emergent Pediatric Intensive Care Unit (ICU) Transfer: Retrospective Analysis (Preprint)

Contact Info

Product

Resources

About