Liang Huan, Carey Kyle A, Jani Priti, Gilbert Emily R, Afshar Majid, Sanchez-Pinto L Nelson, Churpek Matthew M, Mayampurath Anoop
Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison, Madison, WI, United States.
Department of Medicine, University of Chicago, Chicago, IL, United States.
Front Pediatr. 2023 Dec 21;11:1284672. doi: 10.3389/fped.2023.1284672. eCollection 2023.
Critical deterioration in hospitalized children, defined as ward to pediatric intensive care unit (PICU) transfer followed by mechanical ventilation (MV) or vasoactive infusion (VI) within 12 h, has been used as a primary metric to evaluate the effectiveness of clinical interventions or quality improvement initiatives. We explore the association between critical events (CEs), i.e., MV or VI events, within the first 48 h of PICU transfer from the ward or emergency department (ED) and in-hospital mortality.
We conducted a retrospective study of a cohort of PICU transfers from the ward or the ED at two tertiary-care academic hospitals. We determined the association between mortality and occurrence of CEs within 48 h of PICU transfer after adjusting for age, gender, hospital, and prior comorbidities.
Experiencing a CE within 48 h of PICU transfer was associated with an increased risk of mortality [OR 12.40 (95% CI: 8.12-19.23, < 0.05)]. The increased risk of mortality was highest in the first 12 h [OR 11.32 (95% CI: 7.51-17.15, < 0.05)] but persisted in the 12-48 h time interval [OR 2.84 (95% CI: 1.40-5.22, < 0.05)]. Varying levels of risk were observed when considering ED or ward transfers only, when considering different age groups, and when considering individual 12-h time intervals.
We demonstrate that occurrence of a CE within 48 h of PICU transfer was associated with mortality after adjusting for confounders. Studies focusing on the impact of quality improvement efforts may benefit from using CEs within 48 h of PICU transfer as an additional evaluation metric, provided these events could have been influenced by the initiative.
住院儿童的病情急剧恶化被定义为从病房转至儿科重症监护病房（PICU），并在12小时内接受机械通气（MV）或血管活性药物输注（VI），这一指标已被用作评估临床干预措施有效性或质量改进举措的主要指标。我们探讨了从病房或急诊科（ED）转入PICU后的48小时内发生的危急事件（CEs），即MV或VI事件，与院内死亡率之间的关联。
我们对两家三级医疗学术医院中从病房或ED转入PICU的队列进行了回顾性研究。在调整年龄、性别、医院和既往合并症后，我们确定了PICU转入后48小时内死亡率与CEs发生之间的关联。
PICU转入后48小时内发生CE与死亡风险增加相关[比值比（OR）为12.40（95%置信区间：8.12 - 19.23，P < 0.05）]。死亡风险增加在最初12小时内最高[OR为11.32（95%置信区间：7.51 - 17.15，P < 0.05）]，但在12 - 48小时时间段内仍然存在[OR为2.84（95%置信区间：1.40 - 5.22，P < 0.05）]。仅考虑ED或病房转入、不同年龄组以及各个12小时时间段时，观察到了不同程度的风险。
我们证明，在调整混杂因素后，PICU转入后48小时内发生CE与死亡率相关。关注质量改进努力影响的研究可能会受益于将PICU转入后48小时内的CE用作额外的评估指标，前提是这些事件可能受到该举措的影响。
