Reduction of hospital mortality and of preventable cardiac arrest  and death on introduction of a pediatric medical emergency team.
OBJECTIVE
To determine the effect of a medical emergency team (MET) on the incidence of unexpected cardiac arrest and death.


METHODS
Comparison of retrospective data (pre-MET) before introduction of MET with prospective data after introduction of MET system (post-MET).


METHODS
Tertiary care pediatric hospital.


METHODS
A total of 104,780 admissions during a 41-month period pre-MET; 138,424 admissions during 48 months post-MET.


METHODS
Introduction of a MET.


RESULTS
Total hospital deaths decreased from 4.38 to 2.87/ 1000 admissions (risk ratio 0.65, 95% confidence interval [CI] 0.57-0.75, p < 0.0001). Ward unexpected death decreased from 13 (0.12/1000) to 6 (0.04/1000) (risk ratio 0.35, 95% CI 0.13- 0.92, p = 0.03) but unexpected cardiac arrests did not change from 0.19/1000 to 0.17/1000 (risk ratio 0.91, 95% CI 0.50 -1.64, p = 0.75). Thirty-four hospital deaths, including three unexpected deaths (1 out of 72 MET calls), were prevented each year of MET operation. Preventable cardiac arrest (children whose symptoms or signs fulfilled MET calling criteria) decreased from 17 (0.16/ 1000) to 10 (0.07/1000) (risk ratio 0.45, 95% CI 0.20-0.97, p = 0.04) and in whom death decreased from 12 to 2 (0.11/1000 to 0.01/1000) (risk ratio 0.13, 95% CI 0.03-0.56, p = 0.001). Nonpreventable cardiac arrest (children whose symptoms or signs did not fulfill MET calling criteria) increased from 3 to 14 (0.03/1000 to 0.10/1000, p = 0.03) but death did not increase. Survival from cardiac arrest increased from 7 of 20 patients to 17 of 23 (risk ratio 2.11, 95% CI 1.11- 4.02, p = 0.01). Annual calls for urgent assistance were 202 in the post-MET era and 46 during the pre-MET era (ratio 4.4:1).


CONCLUSIONS
Introduction of a MET was associated with reduction of total hospital death and reduction of preventable cardiac arrest and death with increased survival in wards of a pediatric hospital. MET calling criteria identified some but not all children at risk of unexpected cardiac arrest and death.
Tibballs
James
J
Intensive Care Unit and Department of Paediatrics at The University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia. james.tibballs@rch.org.au
Kinney
Sharon
S
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006323:Heart Arrest / Q000401:mortality / Q000517:prevention & control*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010348:Patient Care Team; D010372:Pediatrics; D011446:Prospective Studies; D012189:Retrospective Studies; D014739:Victoria / Q000453:epidemiology