Zachary West, Andrew Jergel, Naveen Muthu, Nikhil Chanani
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引用次数: 0
Abstract
Objective: Cardiopulmonary arrest is rare in pediatrics, but researchers have identified a proxy metric in emergency transfers (ETs) that has not been studied in pediatric cardiology. We aimed to assess the impact of ET on mortality, cardiac intensive care unit (CICU) length of stay (LOS), and hospitalization LOS in pediatric cardiology. We hypothesized that ETs have longer LOS and increased mortality.
Methods: This single-center, retrospective, propensity-score-matched cohort study assessed cardiology acute care unit to CICU transfers between February 1, 2019 and May 9, 2024. A propensity score with predetermined risk factors included age, diagnosis, high-risk diagnosis, surgical status, transfer reason, transfer shift/quarter, and pretransfer LOS. Transfers were classified by timing of qualifying intervention (intubation, vasoactive initiation, or large volume fluid bolus [≥60 mL/kg] administration): emergency if within 1 hour of transfer, urgent if within 1 to 12 hours of transfer, or otherwise no intervention. Outcomes included CICU LOS, posttransfer LOS, and in-hospital mortality.
Results: A total of 625 transfers were identified and 75 (11.9%) met criteria for ET. After successful matching, ETs demonstrated significantly increased in-hospital mortality (25% vs 10%; P = .001), CICU LOS (12.8 days vs 4.12 days; P < .001), and post-CICU transfer LOS (40.18 days vs 19.81 days; P = .012). Additionally, ETs had higher in-hospital mortality than both urgent (OR 3.6; 95% CI, 1.40-11; P = .011) and no intervention transfers (OR 5.3; 95% CI, 2.8-10; P < .001).
Conclusions: ETs are associated with increased LOS and mortality in pediatric cardiology. ETs are a valid proxy measure for clinical deterioration.
目的:心肺骤停在儿科中是罕见的,但研究人员已经确定了紧急转移(ETs)的代理指标,尚未在儿科心脏病学中进行研究。我们旨在评估ET对儿科心脏病学死亡率、心脏重症监护病房(CICU)住院时间(LOS)和住院时间(LOS)的影响。我们假设et有更长的LOS和更高的死亡率。方法:这项单中心、回顾性、倾向评分匹配的队列研究评估了2019年2月1日至2024年5月9日期间心脏病急症病房转重症监护病房的情况。具有预定危险因素的倾向评分包括年龄、诊断、高危诊断、手术状态、转移原因、转移移位/季度和转移前LOS。转移按符合条件的干预时间(插管、血管活性启动或大容量液体灌注[≥60ml /kg]给药)进行分类:转移后1小时内为紧急情况,转移后1至12小时内为紧急情况,否则不进行干预。结果包括CICU LOS、转院后LOS和住院死亡率。结果:总共确定了625例转移,其中75例(11.9%)符合ET的标准。在成功匹配后,ET显着增加了住院死亡率(25% vs 10%; P =。结论:ETs与儿科心脏病患者的LOS和死亡率增加相关。ETs是临床恶化的有效替代指标。