Characteristics and Outcomes of Pediatric Rapid Response With a Respiratory Trigger.

BACKGROUND AND OBJECTIVES: Authors of adult rapid response (RRT) studies have established that RRT triggers play an important role in outcomes, but this association is not studied in pediatrics. In this study, we explore the characteristics and outcomes of pediatric rapid response with a respiratory trigger (Resp-RRT). We hypothesize that outcomes differ on the basis of patients' primary diagnoses at the time of Resp-RRT. METHODS: We conducted a 2-year retrospective observational study at an academic tertiary care pediatric hospital. RESULTS: Among the 1287 Resp-RRTs in 1060 patients, those with a respiratory diagnosis (N = 686) were younger, less likely to have complex chronic conditions, and less likely to have concurrent triggers (P < .01) than those with a nonrespiratory diagnosis (N = 601). Patients with a respiratory diagnosis were more likely to receive noninvasive ventilation, less likely to receive vasoactive support, and had lower 30-day mortality (P < .01). Among those with a respiratory diagnosis, the 541 patients with acute illness were younger, less likely to have complex chronic conditions, and less likely to receive vasoactive support than those with acute on chronic illness (N = 100) (P < .01). CONCLUSIONS: Among pediatric respiratory-triggered RRT events, patients with a respiratory diagnosis were more likely to receive acute respiratory support in ICU but have better long-term outcomes. Presence of complex chronic conditions increases risk of acute respiratory support and mortality. The interplay of primary diagnosis with RRT trigger can potentially inform resource needs and outcomes for pediatric Resp-RRTs.

Repeat Rapid Response Events in Children: Characteristics and Outcomes.

OBJECTIVE: We describe the characteristics and outcomes of pediatric repeat rapid response events within a single hospitalization. We hypothesized that triggers for repeat rapid response and initial rapid response events are similar, and repeat rapid response events are associated with high prevalence of medical complexity and worse outcomes. DESIGN: A 3-year retrospective study. SETTING: High-volume tertiary academic pediatric hospital. PATIENTS: All rapid response events were reviewed to identify repeat rapid response events. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Patient demographics, rapid response triggers, primary clinical diagnoses, illness acuity scores, medical interventions, transfers to ICU, occurrence of critical deterioration, and mortality were reviewed. We reviewed 146 patients with 309 rapid response events (146 initial rapid response and 163 repeat rapid response: 36% < 24 hr, 38% 24 hr to 7 d, and 26% > 7 d after initial rapid response). Median age was 3 years, and 60% were males. Eighty-five percentage of repeat rapid response occurred in medical complexity patients. The triggers for 71% of all repeat rapid response matched with those of initial rapid response. Transfer to ICU occurred in 69 (47%) of initial rapid response and 124 (76%) of repeat rapid response (p < 0.01). The median hospital stay was 11 and 30 days for previously healthy and medical complexity patients, respectively (p = 0.16). ICU readmission at repeat rapid response was associated with longer hospital stay (p < 0.01). Mortality during hospitalization occurred in 14% (all medically complex) of patients after repeat rapid response. Hospital mortality after rapid response is 4.4% per our center's administrative data and 6.7% according to published multicenter data. CONCLUSIONS: Prevalence of medical complexity was high in patients with repeat rapid response compared with that reported for pediatric hospitalizations. Triggers between initial and repeat rapid response events correlated. Transfer to ICU was more likely after repeat rapid response and among repeat rapid response, events with ICU readmissions had a longer length of ICU and hospital stay. Mortality for the repeat rapid response cohort was higher than that for overall rapid responses in our center and per published reports from other centers.

Application of an Asthma Screening Questionnaire in Children with Sickle Cell Disease.

Objective: Asthma in sickle cell disease (SCD) patients is associated with elevated morbidity and mortality. Early detection and initiation of treatment may therefore lead to improved outcome. Utility of an asthma screening questionnaire to identify obstructive airway disease and physician diagnosed asthma in children with SCD at an outpatient setting as an effective, easy-to-administer screening tool has not previously been evaluated in this population. Methods: A previously validated asthma screening questionnaire and spirometry were prospectively administered to 41 SCD children at a routine clinic visit. Results: Prevalence of obstructive airway was 51.2% (n = 21) and physician diagnosis of asthma 33.3% (n = 13). Sensitivity (40%) and specificity (75%) of the questionnaire was poor in detecting obstructive airway disease, but sensitivity (77%), specificity (100%), positive predictive value (100%), and negative predictive value (90%) were high in detecting physician diagnosis of asthma. Conclusion: An asthma screening questionnaire could be a useful tool in identifying at-risk SCD children who may benefit from further management.