387 - Patient characteristics associated with hospital admission or antiarrhythmic medication changes after emergency department evaluation of supraventricular tachycardia

Poster Number: 387
Publication Number: 387.314

Kyle A. Schmucker, UPMC, Pittsburgh, PA, United States; Robert Tisherman, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Caroline S. Morris, UPMC Childrens Hospital of Pittsburgh, pittsburgh, PA, United States; Mioara Manole, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Gaurav Arora, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States; Jennifer Dunnick, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States

Background: Supraventricular tachycardia (SVT) is a relatively frequent diagnosis in the pediatric emergency department (ED). However, there are no consensus guidelines for ED disposition and there are limited data on ED outcomes. Better characterization of patients who require admission or antiarrhythmic medication changes may avoid potentially unnecessary transfers from referring facilities.

Objective: To identify potentially avoidable transfers, defined as patients with SVT treated in a pediatric ED who were not admitted to the hospital or did not have antiarrhythmic medication changes.

Design/Methods: This study was conducted at a tertiary children’s hospital affiliated with an academic university that serves as the primary referral center in the area. A retrospective review of children aged 0-18 years seen in the pediatric ED for SVT was conducted using electronic medical record data over a ten-year period. Patients with congenital cardiac disease or prior cardiac surgeries were excluded. Variables of interest included age, prior diagnosis of SVT, current antiarrhythmic medications, history of Wolff-Parkinson-White syndrome, other medical comorbidities, intercurrent illness, transfer, number adenosine doses given, electric cardioversion, duration of SVT, cardiology evaluation, and presence of preexcitation. Multivariable logistic regression analysis was used to determine the association between the variables of interest and the outcome of admission or change to antiarrhythmic medications.

Results: We analyzed 155 patients encounters which met inclusion criteria. Of these 48.4% were admitted to the hospital or discharged with antiarrhythmic medication changes. Admission or change to antiarrhythmic medication was associated with younger age (OR 0.81, CI 0.72-0.89, p < 0.001), increased number of adenosine doses (OR 2.01, CI 1.39-3.01, p < 0.001), history of preexitation (OR 6.22, CI 2.19-20.36, p=0.001), intercurrent illness (OR 3.27, CI 1.14-10.13, p=0.03), evaluation in ED by cardiology (OR 6.09, CI 2.34-18.08, p < 0.001).Conclusion(s): Half of patients treated in a pediatric ED for SVT are discharged without changes in medications. Younger age, requiring multiple doses of adenosine, history of preexcitation, intercurrent illness, and in- person cardiology consultation are associated with hospital admission or antiarrhythmic medication changes, representing high value care when considering transfer from a referring facility. Careful consideration of these patient characteristics may reduce potentially avoidable transfers and admissions.
schmucker CV 10.28.21.pdf