Acute heart failure syndromes in the pediatric emergency department.
OBJECTIVE
The objectives of this study were to (1) describe the clinical presentation of acute heart failure syndromes (AHFS) in the pediatric emergency department (ED) and (2) determine the physician treatment regimens and outcomes in the same population.


METHODS
This was a cross-sectional study of patients who presented with AHFS to the ED at our institution from January 2003 to October 2006. We defined AHFS as "the gradual or rapid deterioration in heart failure signs and symptoms resulting in a need for urgent therapy." Patients were included when they had documented signs or symptoms of HF attributable to ventricular dysfunction. Patients were excluded when they were older than 21 years or had HF symptoms that were attributable to left-to-right intracardiac shunting or left-sided obstructive lesions. All eligible ED patient visits were adjudicated by a pediatric HF specialist.


RESULTS
Fifty-seven patient visits to the ED met inclusion criteria. There was a significant difference in time from arrival to treatment with a diuretic when the therapy was started in the ED rather than in the inpatient units. Median time to initiation of a vasoactive agent was significantly less for patients whose infusions were started in the ED compared with the ICU. Two patients died in the ED, and overall mortality or need for mechanical circulatory support for hospitalized patients was 18% (n = 10).


CONCLUSIONS
These data yield important insight into the clinical features and initial treatment of children who present with AHFS in the ED and may allow for improved recognition and treatment of this clinical syndrome.
Macicek
Scott M
SM
Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas 77030, USA.
Macias
Charles G
CG
Jefferies
John L
JL
Kim
Jeffrey J
JJ
Price
Jack F
JF
D000208:Acute Disease; D001774:Blood Chemical Analysis; D002316:Cardiotonic Agents / Q000008:administration & dosage; D002648:Child; D003102:Colloids; D000077324:Crystalloid Solutions; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage
D002316:Cardiotonic Agents; D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D049994:Sodium Potassium Chloride Symporter Inhibitors