Al-Harbi Samah
Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
Department of Pediatrics, King Abdulaziz University Hospital, Jeddah 22252, Saudi Arabia.
Healthcare (Basel). 2024 Feb 21;12(5):518. doi: 10.3390/healthcare12050518.
Pediatric rapid response teams (RRTs) are expected to significantly lower pediatric mortality in healthcare settings. This study evaluates RRTs' effectiveness in decreasing cardiac arrests and unexpected Pediatric Intensive Care Unit (PICU) admissions. A quasi-experimental study (2014-2017) at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, involved 3261 pediatric inpatients, split into pre-intervention (1604) and post-intervention (1657) groups. Baseline pediatric warning scores and monthly data on admissions, transfers, arrests, and mortality were analyzed pre- and post-intervention. Statistical methods including bootstrapping, segmented regression, and a Zero-Inflation Poisson model were employed to ensure a comprehensive evaluation of the intervention's impact. RRT was activated 471 times, primarily for respiratory distress (29.30%), sepsis (22.30%), clinical anxiety (13.80%), and hematological abnormalities (6.7%). Family concerns triggered 0.1% of activations. Post-RRT implementation, unplanned PICU admissions significantly reduced (RR = 0.552, 95% CI 0.485-0.628, < 0.0001), and non-ICU cardiac arrests were eliminated (RR = 0). Patient care improvement was notable, with a -9.61 coefficient for PICU admissions (95% CI: -12.65 to -6.57, < 0.001) and a -1.641 coefficient for non-ICU cardiac arrests (95% CI: -2.22 to -1.06, < 0.001). Sensitivity analysis showed mixed results for PICU admissions, while zero-inflation Poisson analysis confirmed a reduction in non-ICU arrests. The deployment of pediatric RRTs is associated with fewer unexpected PICU admissions and non-ICU cardiopulmonary arrests, indicating improved PICU management. Further research using robust scientific methods is necessary to conclusively determine RRTs' clinical benefits.
儿科快速反应小组（RRTs）有望显著降低医疗机构中的儿科死亡率。本研究评估了RRTs在减少心脏骤停和意外的儿科重症监护病房（PICU）入院方面的有效性。沙特阿拉伯吉达阿卜杜勒阿齐兹国王大学医院进行的一项准实验研究（2014 - 2017年），涉及3261名儿科住院患者，分为干预前组（1604名）和干预后组（1657名）。在干预前后分析了儿科基线预警评分以及关于入院、转院、心脏骤停和死亡率的月度数据。采用了包括自助法、分段回归和零膨胀泊松模型在内的统计方法，以确保对干预效果进行全面评估。RRT被激活471次，主要原因是呼吸窘迫（29.30%）、败血症（22.30%）、临床焦虑（13.80%）和血液学异常（6.7%）。家庭担忧引发了0.1%的激活事件。在实施RRT后，计划外的PICU入院显著减少（RR = 0.552，95% CI 0.485 - 0.628，< 0.0001），非ICU心脏骤停被消除（RR = 0）。患者护理得到显著改善，PICU入院的系数为 - 9.61（95% CI： - 12.65至 - 6.57，< 0.001），非ICU心脏骤停的系数为 - 1.641（95% CI： - 2.22至 - 1.06，< 0.001）。敏感性分析显示PICU入院结果不一，而零膨胀泊松分析证实非ICU心脏骤停有所减少。儿科RRT的部署与意外的PICU入院和非ICU心肺骤停减少相关，表明PICU管理得到改善。需要使用可靠的科学方法进行进一步研究，以最终确定RRT的临床益处。
