title: Rapid Response Team Activations in Pediatric Surgical Patients.
abstract: IntroductionThe rapid response team (RRT) is a multidisciplinary team who evaluates hospitalized patients for concerns of nonemergent clinical deterioration. RRT evaluations are mandatory for children whose Pediatric Early Warning System (PEWS) score (assessment of child's behavior, cardiovascular and respiratory status) is ≥4. We aimed to determine if there were differences in characteristics of RRT calls between children who were admitted primarily to either medical or surgical services. We hypothesized that RRT activations would be called for less severely ill children with lower PEWS score on surgical services compared with children admitted to a medical service.Materials and MethodsWe performed a retrospective review of all children with RRT activations between January 2008 and April 2015 at a tertiary care pediatric hospital. We evaluated the characteristics of RRT calls and made comparisons between RRT calls made for children admitted primarily to medical or surgical services.ResultsA total of 2,991 RRT activations were called, and 324 (11%) involved surgical patients. Surgical patients were older than medical patients (median: 7 vs. 4 years;p< 0.001). RRT evaluations were called for lower PEWS score in surgical patients compared with medical (median: 3 vs. 4,p< 0.001). Surgical patients were more likely to remain on the inpatient ward following the RRT (51 vs. 39%,p< 0.001) and were less likely to require an advanced airway than medical patients (0.9 vs. 2.1%;p= 0.412). RRT evaluations did not differ between day and night shifts (52% day vs. 48% night;p= 0.17). All surgical patients and all but one medical patient survived the event; surgical patients were more likely to survive to hospital discharge (97 vs. 91%,p< 0.001)ConclusionsRRT activations are rare events among pediatric surgical patients. When compared with medical patients, RRT evaluation is requested for surgical patients with a lower PEWS score and these children are less likely to require transfer to a higher level of care, suggesting that pediatric surgery team, families, and nursing staff may not be as comfortable with clinical deterioration.
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, United States.
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Acker
authors.affiliation: Division of Pediatric Critical Care, Children's Hospital Colorado, Aurora, Colorado, United States.
authors.forename: Beth
authors.initials: B
authors.lastname: Wathen
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado, United States.
authors.forename: Genie E
authors.initials: GE
authors.lastname: Roosevelt
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado, United States.
authors.forename: Lauren R S
authors.initials: LR
authors.lastname: Hill
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, United States.
authors.forename: Anna
authors.initials: A
authors.lastname: Schubert
authors.affiliation: Pediatric Hospital Medicine, Children's Hospital Colorado, Aurora, Colorado, United States.
authors.forename: Jenny
authors.initials: J
authors.lastname: Reese
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado, United States.
authors.forename: Denis D
authors.initials: DD
authors.lastname: Bensard
authors.affiliation: Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado, United States.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Kulungowski
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003120:Colorado; D005260:Female; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013503:Surgery Department, Hospital