Clinical profile of hospitalized children provided with urgent assistance from a medical emergency team.
OBJECTIVE
The purpose of this work was to describe the frequency, characteristics, and outcomes of critical events and hospitalized children requiring medical emergency team review.


METHODS
We conducted an audit of prospectively collected medical emergency team forms and a retrospective review of medical charts during an 18-month period at a tertiary pediatric hospital in Australia. Critical events were defined as cardiac arrest, endotracheal intubation on the ward, reversal of analgesia or sedation, fluid resuscitation at >/=40 mL/kg, hyponatremia (serum sodium level of </=125 mmol/L), hypernatremia (serum sodium level of >/=155 mmol/L), hypoglycemia (glucose level of </=2 mmol/L), or severe metabolic acidosis (pH </= 7.1).


RESULTS
A total of 172 children had 225 medical emergency team calls (10.6 calls per 1000 hospital admissions and 2.0 calls per 1000 patient-days). Forty-two percent of calls were for infants <1 year old. Preexisting chronic disease was common, with 20% having a chronic underlying neurologic disorder. Forty-four percent of the children were postoperative. The mortality rate of the 172 children was 7.6% in the hospital and 13.4% within 1 year. Thirty-three children had a critical event, with reversal of analgesia being the most common event (n = 11). Postoperative children were more frequently seen in the critical-event group (64% vs 40%). Hospital and 1-year mortality rates were higher for children who had a critical event (16.1% vs 22.6%, respectively) than those who did not (5.7% vs 11.3%).


CONCLUSIONS
Chronic and complex illnesses were prevalent among children provided with urgent medical assistance from the medical emergency team in a tertiary hospital. Children in the postoperative phase were overrepresented among those with a critical event. A critical event significantly increased the risk of hospital mortality. Greater knowledge of high-risk groups is required to further improve outcomes for hospitalized children.
Clinical Quality Safety Unit, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia. sharon.kinney@rch.org.au
Sharon
S
Kinney
James
J
Tibballs
Linda
L
Johnston
Trevor
T
Duke
D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010348:Patient Care Team; D012189:Retrospective Studies