Feder Joshua, Ramsay Christa, Tsampalieros Anne, Barrowman Nick, Richardson Kara, Rizakos Sara, Sweet Julia, McNally James Dayre, Lobos Anna-Theresa
Department of Pediatrics, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
Department of Respiratory Therapy, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
J Pediatr Intensive Care. 2022 Mar 8;13(4):379-388. doi: 10.1055/s-0042-1744297. eCollection 2024 Dec.
This study was conducted to investigate whether outcomes of medical emergency team (MET) activations differ by time of day of hospitalized pediatric patients. This is a retrospective cohort study conduct at a tertiary pediatric hospital. Data were extracted from the charts of 846 patients (with one or more MET activations) over a 5-year period. Also can remove hospital names and affiliated institution from the body of the text as readers can find this information in the author list. Patients included children <18 years, admitted to a pediatric ward, who experienced a MET activation between January 1, 2016 and December 31, 2020. We excluded patients reviewed by the MET during a routine follow-up, planned pediatric intensive care unit (PICU) admissions from the ward, and MET activation in out-patient settings, post-anesthesia care unit, and neonatal intensive care unit. There was no intervention. A total of 1,230 MET encounters were included as part of the final analysis. Daytime (08:00-15:59) MET activation was associated with increased PICU admission (25.3%, = 0.04). There was some evidence of a higher proportion of critical deterioration events (CDEs) during daytime MET activation; however, this did not reach statistical significance (24%, = 0.09). The highest MET dosage occurred during the evening hours, 16:00 to 23:59 (15/1,000 admissions), and it was lowest overnight, 00:00 to 07:59 (8.8/1,000 admissions, < 0.001). This period of lowest MET dosage immediately preceded the highest likelihood of PICU admission (08:00, 37.5%) and CDE (09:00, 30.2%). Following the period of lowest MET activity overnight, MET activations during early daytime hours were associated with the highest likelihood of unplanned PICU admission and CDEs. This work identifies potential high-risk periods for undetected critical deterioration and targets for future quality improvement.
本研究旨在调查住院儿科患者医疗急救团队（MET）启动的结果是否因一天中的时间不同而有所差异。这是一项在一家三级儿科医院进行的回顾性队列研究。数据从846例患者（有一次或多次MET启动）的病历中提取，时间跨度为5年。此外，可从文本主体中删除医院名称和附属机构，因为读者可在作者列表中找到此信息。患者包括年龄小于18岁、入住儿科病房、在2016年1月1日至2020年12月31日期间经历过MET启动的儿童。我们排除了在常规随访期间由MET评估的患者、从病房计划转入儿科重症监护病房（PICU）的患者，以及门诊、麻醉后护理单元和新生儿重症监护病房的MET启动情况。未进行干预。共有1230次MET会诊被纳入最终分析。白天（08:00 - 15:59）MET启动与PICU入院率增加相关（25.3%，P = 0.04）。有一些证据表明白天MET启动期间严重病情恶化事件（CDE）的比例较高；然而，这未达到统计学显著性（24%，P = 0.09）。MET启动剂量最高发生在傍晚时段，即16:00至23:59（每1000例入院中有15次），而在夜间最低，即00:00至07:59（每1000例入院中有8.8次，P < 0.001）。MET启动剂量最低的这段时间紧接着PICU入院可能性最高的时段（08:00，37.5%）和CDE可能性最高的时段（09:00，30.2%）。在夜间MET活动最低的时段之后，白天早些时候的MET启动与非计划PICU入院和CDE的可能性最高相关。这项工作确定了未被发现的严重病情恶化的潜在高危时段以及未来质量改进的目标。
