335 - Which Patients Deteriorate Rapidly? Identifying Risk Factors for Emergent ICU Transfer

Poster Number: 335
Publication Number: 335.214

Kate Lucey, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Roderick C. Jones, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Rebecca Stephen, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: In-hospital arrests on pediatric acute care units are rare events associated with significant morbidity and mortality. Emergent transfers (ETs) are defined as patient transfers from acute care units to an intensive care unit (ICU) requiring intubation, inotropes, or 3 or more fluid boluses within the first hour of, or prior to, ICU admission. ETs are associated with increased mortality and length of stay and are a validated outcome measure for evaluating hospital rapid response systems. At our institution, patients with concern for clinical deterioration on acute care units are evaluated by the Critical Assessment Team (CAT). We hypothesized that there may be risk factors associated with CAT activations that result in ET.

Objective: To evaluate if specific patient characteristics or care team characteristics are associated with ET.

Design/Methods: Logs of CAT activations from January 2019-December 2020 were aggregated. For each CAT activation, the electronic medical record was queried to extract data on patient demographics, care team and treatment factors, and ICU transfers. The pediatric complex chronic conditions (CCC) classification system version 2 was used to define patients’ underlying conditions. Descriptive statistics and bivariate associations between risk factors and ETs were performed using SAS version 9.4.

Results: Over 24 months there were 1,117 CAT activations in acute care units among 814 distinct patients (Table 1). 652 (58%) of evaluations resulted in ICU transfer. Of these, 46 (7%) met the ET definition. Statistically significant bivariate associations with an ET were found for age 18 years or older (risk ratio=4.1), Hematology/Oncology service (3.3), any CCC (2.5), and these specific CCCs: malignancy (3.1), hematologic or immunologic (2.8), renal and urologic (2.1), and other congenital or genetic (3.5). Hispanic/Latinx (HL) patients had the highest rate of ET (6%), but this rate was not significantly higher than non-HL patients. No statistically significant associations were noted with preferred language or care setting factors impacting staffing (e.g., CAT activation on a weekend) (Table 2).Conclusion(s): Adult patients, patients with medical complexity, and patients on the Hematology/Oncology service had a higher risk of ET. Although not statistically significant, there were higher rates of ETs among HL patients and patients whose preferred language is not English. This should be further evaluated with a larger sample size. By identifying risk factors associated with ET, we can focus rapid response system quality improvement and education efforts on patients at highest risk.
Table 1Characteristics of patients for whom Critical Assessment Team activations occurred
Table 2Bivariate analysis of associations between risk factors and Critical Assessment Team activations resulting in Emergent Transfer