title: Frequency of medical emergency team activation prior to pediatric cardiopulmonary resuscitation.
abstract: Medical Emergency Teams (METs) are designed to respond to signs of clinical decline in order to prevent cardiopulmonary arrest and reduce mortality. The frequency of MET activation prior to pediatric cardiopulmonary resuscitation (CPR) is unknown.
  
  
  
  Within the Get With The Guidelines-Resuscitation Registry (GWTG-R), we identified children with bradycardia or cardiac arrest requiring CPR on the general inpatient or telemetry floors from 2007 to 2013. We examined the frequency with which CPR outside the ICU was preceded by a MET evaluation. In cases where MET evaluation did not occur, we examined the frequency of severely abnormal vital signs at least 1hour prior to CPR that could have prompted a MET evaluation but did not.
  
  
  
  Of 215 children from 23 hospitals requiring CPR, 48 (22.3%) had a preceding MET evaluation. Children with MET evaluation prior to CPR were older (6.8±6.5 vs. 3.1±4.7 years of age, p<0.001) and were more likely to have metabolic/electrolyte abnormalities (18.8% vs. 5.4%, p=0.006), sepsis (16.7% vs. 4.8%, p=0.01), or malignancy (22.9% vs. 5.4%, p<0.001). Among patients who did not have a MET called and with information on vital signs, 55/141 (39.0%) had at least one abnormal vital sign that could have triggered a MET.
  
  
  
  The majority of pediatric patients requiring CPR for bradycardia or cardiac arrest do not have a preceding MET evaluation despite a significant number meeting criteria that could have triggered the MET. This suggests opportunities to more efficiently use MET teams in routine care.
authors.affiliation: Children's Mercy Hospitals and Clinics, Kansas City, MO, United States. Electronic address: njayaram@cmh.edu.
authors.forename: Natalie
authors.initials: N
authors.lastname: Jayaram
authors.affiliation: Pembroke Hill High School, Kansas City, MO, United States.
authors.forename: Maya L
authors.initials: ML
authors.lastname: Chan
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, MO, United States.
authors.forename: Fengming
authors.initials: F
authors.lastname: Tang
authors.affiliation: The Hospital for Sick Children, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Parshuram
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, MO, United States.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Chan
mesh_terms: D001919:Bradycardia / Q000175:diagnosis* / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D002648:Child; D000075902:Clinical Deterioration; D057210:Delayed Diagnosis; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis* / Q000453:epidemiology; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D011446:Prospective Studies; D012042:Registries; D055986:Vital Signs
keywords: Cardiopulmonary resuscitation; Medical emergency team; Pediatrics