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

IF 2.1 Q1 Nursing
Anisha K Coughlin, Kristen A Smith, Maria C Pliakas, Julie Sturza, Katherine E Bates, Erin F Carlton
{"title":"Association of Hospitalization-Level Characteristics With Pediatric Rapid Response Team Outcomes.","authors":"Anisha K Coughlin, Kristen A Smith, Maria C Pliakas, Julie Sturza, Katherine E Bates, Erin F Carlton","doi":"10.1542/hpeds.2025-008428","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hospital pediatrics","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1542/hpeds.2025-008428","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"Nursing","Score":null,"Total":0}
引用次数: 0

Abstract

Background and objectives: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

背景和目的:许多机构已经实施了快速反应小组(RRTs)来评估病情恶化的患者。急性恶化事件常被用作儿童死亡率的替代指标;然而,失代偿事件的危险因素并没有很好地定义。方法:我们确定了一家四级护理医院2019年1月至2024年6月儿科入院的所有RRT事件。我们的主要结局是RRT事件发生后6小时内的急性恶化,包括插管或血管活性药物的使用。我们还报告转移到重症监护病房(ICU)的比率。我们比较了有和没有急性恶化事件的患者和住院水平的特征。最后,我们使用逻辑回归来确定与急性恶化相关的危险因素,包括年龄、性别、医疗复杂性、RRT时的呼吸支持和RRT时的主要服务。结果:我们确定了2797例RRTs,其中212例(7.6%)在6小时内导致急性恶化事件;1545例(55%)RRT事件导致转至ICU。在考虑年龄、性别、患者医疗复杂性、主要服务和呼吸支持的多变量logistic回归模型中,RRT时的呼吸支持和患者医疗复杂性与急性恶化事件独立相关。具体而言,RRT事件时高流量鼻插管与较低的急性恶化几率相关(优势比,0.50;95% CI, 0.32-0.79),复杂的慢性疾病与较高的急性恶化几率相关(优势比,3.11;95% CI, 1.43-6.80)。结论:住院水平特征可用于评估机构儿科RRT系统在预防急性恶化事件、预测护理升级、告知RRT资源分配和改进工作方面的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Hospital pediatrics
Hospital pediatrics Nursing-Pediatrics
CiteScore
3.70
自引率
0.00%
发文量
204
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信