Published online June 2, 2008
PEDIATRICS Vol. 121 No. 6 June 2008, pp. e1577-e1584 (doi:10.1542/peds.2007-1584)
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ARTICLE

Clinical Profile of Hospitalized Children Provided With Urgent Assistance From a Medical Emergency Team

Sharon Kinney, RN, MNa,b,c, James Tibballs, MD, BMedSc, MEd, MBA, MHlth, MedLaw, GradDipArts(Fr), FANZCA, FJFICMc,d,e, Linda Johnston, RN, PhDb,c,f and Trevor Duke, MD, FRACP, FJFICMc,d,e

a Clinical Quality Safety Unit
d Intensive Care Unit
f Department of Neonatology, Royal Children's Hospital, Melbourne, Australia
b School of Nursing
e Department of Paediatrics, University of Melbourne, Melbourne, Australia
c Murdoch Children's Research Institute, Parkville, Victoria, Australia

OBJECTIVE. The purpose of this work was to describe the frequency, characteristics, and outcomes of critical events and hospitalized children requiring medical emergency team review.

PATIENTS AND METHODS. We conducted an audit of prospectively collected medical emergency team forms and a retrospective review of medical charts during an 18-month period at a tertiary pediatric hospital in Australia. Critical events were defined as cardiac arrest, endotracheal intubation on the ward, reversal of analgesia or sedation, fluid resuscitation at ≥40 mL/kg, hyponatremia (serum sodium level of ≤125 mmol/L), hypernatremia (serum sodium level of ≥155 mmol/L), hypoglycemia (glucose level of ≤2 mmol/L), or severe metabolic acidosis (pH ≤ 7.1).

RESULTS. A total of 172 children had 225 medical emergency team calls (10.6 calls per 1000 hospital admissions and 2.0 calls per 1000 patient-days). Forty-two percent of calls were for infants <1 year old. Preexisting chronic disease was common, with 20% having a chronic underlying neurologic disorder. Forty-four percent of the children were postoperative. The mortality rate of the 172 children was 7.6% in the hospital and 13.4% within 1 year. Thirty-three children had a critical event, with reversal of analgesia being the most common event (n = 11). Postoperative children were more frequently seen in the critical-event group (64% vs 40%). Hospital and 1-year mortality rates were higher for children who had a critical event (16.1% vs 22.6%, respectively) than those who did not (5.7% vs 11.3%).

CONCLUSIONS. Chronic and complex illnesses were prevalent among children provided with urgent medical assistance from the medical emergency team in a tertiary hospital. Children in the postoperative phase were overrepresented among those with a critical event. A critical event significantly increased the risk of hospital mortality. Greater knowledge of high-risk groups is required to further improve outcomes for hospitalized children.

Key Words: critical illness • child • cardiopulmonary resuscitation • medical emergency team • mortality • morbidity

Abbreviations: MET—medical emergency team • CI—confidence interval

Accepted Nov 26, 2007.


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