Abstract
Objective
The incidence of deterioration and associated characteristics are largely unknown
for children transported for admission from referring emergency departments (EDs)
to general inpatient units. This study describes this population and identifies associated
preadmission characteristics.
Methods
This single-center cohort study included children ≤ 18 years old transferred from
an ED and directly admitted to general inpatient units from 2016 to 2019. Deterioration
was defined as 1 or more of the following occurring within 24 hours of admission:
rapid response team activation, transfer to the intensive care unit (ICU), or cardiac
or respiratory arrest. ICU transfer was the secondary outcome. Logistic regression
was performed.
Results
One thousand nine hundred eighty-eight patients were included; the median age was
4.2 years, 53.9% were male, and 44.1% had respiratory diagnoses. Deterioration occurred
in 135 (6.8%) children overall and in 10.1% of children with respiratory complaints.
Deterioration was associated with ≥ 2 complex chronic conditions (adjusted odds ratio
[aOR] = 2.09; 95% confidence interval [CI], 1.04-4.19) and a longer stabilization
time (per 10 minutes) (aOR = 1.17; 95% CI, 1.01-1.36). ICU transfer was associated
with ≥ 2 complex chronic conditions (aOR = 2.33; 95% CI, 1.13-4.80), supplemental
oxygen via nasal cannula (aOR = 2.13; 95% CI, 1.18-3.85), and nebulizer treatment
(aOR = 2.77; 95% CI, 1.21-6.35).
Conclusion
Deterioration was experienced by 7% of children admitted to a general unit, with the
majority having respiratory complaints. Transport teams should consider the potential
for increased risk of deterioration among children with respiratory disease, multiple
complex chronic conditions, and a nasal cannula or nebulizer therapy. The clinical
significance of marginally longer stabilization times is unclear and warrants further
investigation.
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Article Info
Publication History
Published online: May 27, 2022
Footnotes
Thank you to Dr. Denise Goodman for her invaluable review of the manuscript.
Identification
Copyright
© 2022 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.
