Acworth Jason, Ryan Connor, Acworth Elliott, Farah Zahir Syeda
Queensland Children's Hospital, 501 Stanley St, South Brisbane, QLD 4101, Australia.
Faculty of Medicine, University of Queensland, Herston Rd, Herston, QLD 4006, Australia.
Resusc Plus. 2024 Nov 16;20:100823. doi: 10.1016/j.resplu.2024.100823. eCollection 2024 Dec.
Rapid Response Systems are hospital-wide patient-focused systems aiming to improve recognition of acute deterioration in patients and trigger a rapid response aimed at preventing potentially avoidable adverse events such as cardiac arrest and death. In 1994, the Royal Children's Hospital in Brisbane, Australia, was one of the first institutions to adopt a paediatric rapid response system (RRS). The purpose of this study was to investigate the impacts of both introduction of a paediatric RRS and increasing RRS activations (MET dose) on hospital mortality.
Prospectively collected data from institutional databases at a specialist paediatric hospital was used to determine hospital mortality rate pre- and post- implementation of the RRS. An interrupted time series model using segmented regression was utilised to assess the pre-intervention trend, as well as immediate and sustained effects of RRS implementation on hospital mortality. Univariate linear regression examined potential effects of MET dose on mortality.
Hospital mortality rate did not change significantly over 15 years before RRS implementation. In the first year after implementation, mortality rate fell significantly (-1.4; 95 %CI -2.27 to -0.52; p = 0.0027). For each year that passed after the intervention, there was no significant change in hospital mortality rate (Estimate: -0.08; 95 %CI -0.17 to 0.02; p = 0.11). Univariate linear regression modelling showed that with every unit increase in MET Dose, hospital mortality rate decreased by -0.13 (95 % CI: -0.27 to 0; p = 0.05).
Utilising data from one of the earliest and longest duration single-centre cohort of paediatric MET events, this study reaffirms the association between implementation of a paediatric RRS and decreased hospital mortality. The study also provides novel evidence of the impact of MET dose on patient outcome in the paediatric population. It is recommended that factors influencing the benefit of rapid response systems in paediatric populations are further identified so that this life saving initiative can be optimised.
快速反应系统是全院范围内以患者为中心的系统，旨在提高对患者急性病情恶化的识别能力，并引发快速反应，以预防心脏骤停和死亡等潜在可避免的不良事件。1994年，澳大利亚布里斯班的皇家儿童医院是首批采用儿科快速反应系统（RRS）的机构之一。本研究的目的是调查引入儿科RRS以及增加RRS激活次数（MET剂量）对医院死亡率的影响。
使用从一家专科儿童医院的机构数据库中前瞻性收集的数据来确定RRS实施前后的医院死亡率。采用分段回归的中断时间序列模型来评估干预前的趋势，以及RRS实施对医院死亡率的即时和持续影响。单变量线性回归分析了MET剂量对死亡率的潜在影响。
在RRS实施前的15年里，医院死亡率没有显著变化。实施后的第一年，死亡率显著下降（-1.4；95%置信区间-2.27至-0.52；p = 0.0027）。干预后的每一年，医院死亡率没有显著变化（估计值：-0.08；95%置信区间-0.17至0.02；p = 0.11）。单变量线性回归模型显示，MET剂量每增加一个单位，医院死亡率下降-0.13（95%置信区间：-0.27至0；p = 0.05）。
本研究利用最早且持续时间最长的单中心儿科MET事件队列之一的数据，再次证实了儿科RRS的实施与降低医院死亡率之间的关联。该研究还提供了MET剂量对儿科患者结局影响的新证据。建议进一步确定影响儿科人群快速反应系统效益的因素，以便优化这一挽救生命的举措。
