Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Section of Critical Care Medicine and Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Pediatr Crit Care Med. 2018 Apr;19(4):361-368. doi: 10.1097/PCC.0000000000001457.
We describe the characteristics and outcomes of pediatric repeat rapid response events within a single hospitalization. We hypothesized that triggers for repeat rapid response and initial rapid response events are similar, and repeat rapid response events are associated with high prevalence of medical complexity and worse outcomes.
A 3-year retrospective study.
High-volume tertiary academic pediatric hospital.
All rapid response events were reviewed to identify repeat rapid response events.
None.
Patient demographics, rapid response triggers, primary clinical diagnoses, illness acuity scores, medical interventions, transfers to ICU, occurrence of critical deterioration, and mortality were reviewed. We reviewed 146 patients with 309 rapid response events (146 initial rapid response and 163 repeat rapid response: 36% < 24 hr, 38% 24 hr to 7 d, and 26% > 7 d after initial rapid response). Median age was 3 years, and 60% were males. Eighty-five percentage of repeat rapid response occurred in medical complexity patients. The triggers for 71% of all repeat rapid response matched with those of initial rapid response. Transfer to ICU occurred in 69 (47%) of initial rapid response and 124 (76%) of repeat rapid response (p < 0.01). The median hospital stay was 11 and 30 days for previously healthy and medical complexity patients, respectively (p = 0.16). ICU readmission at repeat rapid response was associated with longer hospital stay (p < 0.01). Mortality during hospitalization occurred in 14% (all medically complex) of patients after repeat rapid response. Hospital mortality after rapid response is 4.4% per our center's administrative data and 6.7% according to published multicenter data.
Prevalence of medical complexity was high in patients with repeat rapid response compared with that reported for pediatric hospitalizations. Triggers between initial and repeat rapid response events correlated. Transfer to ICU was more likely after repeat rapid response and among repeat rapid response, events with ICU readmissions had a longer length of ICU and hospital stay. Mortality for the repeat rapid response cohort was higher than that for overall rapid responses in our center and per published reports from other centers.
我们描述了在单次住院期间儿科重复快速反应事件的特征和结果。我们假设，重复快速反应和初始快速反应事件的触发因素相似，且重复快速反应事件与高患病率的医疗复杂性和更差的结局相关。
一项为期 3 年的回顾性研究。
高容量的三级学术儿科医院。
所有快速反应事件均进行了审查，以确定重复快速反应事件。
无。
回顾了患者的人口统计学特征、快速反应触发因素、主要临床诊断、疾病严重程度评分、医疗干预、转入 ICU、发生危急恶化和死亡率。我们共回顾了 146 名患者的 309 次快速反应事件（146 次初始快速反应和 163 次重复快速反应：36%＜24 小时，38%24 小时至 7 天，26%＞7 天）。中位年龄为 3 岁，60%为男性。85%的重复快速反应发生在医疗复杂性患者中。所有重复快速反应的触发因素中有 71%与初始快速反应相匹配。69 例（47%）初始快速反应和 124 例（76%）重复快速反应患者转入 ICU（p＜0.01）。既往健康患者的中位住院时间为 11 天，而医疗复杂性患者为 30 天（p=0.16）。重复快速反应后 ICU 再入院与更长的住院时间相关（p＜0.01）。重复快速反应后，住院期间死亡率为 14%（均为医疗复杂性）。根据我们中心的行政数据，快速反应后院内死亡率为 4.4%，根据多中心发表数据为 6.7%。
与儿科住院患者的报告相比，重复快速反应患者的医疗复杂性患病率较高。初始快速反应和重复快速反应事件之间的触发因素相关。重复快速反应后更有可能转入 ICU，且在重复快速反应中，有 ICU 再入院的患者 ICU 住院时间和总住院时间更长。重复快速反应队列的死亡率高于我们中心的总体快速反应，也高于其他中心的发表报告。
