Clinical Profile of Children Requiring Early Unplanned Admission to the PICU

Abstract

Objective: The goal of this study was to describe the frequency, characteristics, and outcomes of children who require early unplanned admission to the PICU within 24 hours of hospitalization from the emergency department. Methods: This study was a retrospective audit of 24 months of prospectively collected medical emergency team records at a tertiary pediatric hospital in Canada. Our review identified 39 hospitalized children who had an activation that resulted in unplanned admission to the PICU within 24 hours of admission from the ED. Results: Forty-six percent of the study subjects were infants aged <1 year, and 64% were male. Respiratory complaints were the most common reason for hospitalization (59%). Preexisting medical conditions (51%), abnormal respiratory rates (46%), abnormal heart rates (33%), abnormal blood gas values (49%), high supplemental oxygen requirement (23%), and treatment with nebulized medications (46%), intravenous fluids (33%), and antibiotics (33%) were common. The median time to medical emergency team activation was 9.4 hours (interquartile range: 4.4–14.5). Nearly one-half (49%) of the patients required a significant intervention after admission to the PICU, with a mean length of stay of 3.4 days and a mortality rate of 5%. Conclusions: Male subjects, infants aged <1 year, and children with respiratory complaints accounted for a large proportion of children requiring early unplanned admission to the PICU within 24 hours of hospitalization from the ED. Further studies are required to determine which factors are associated with deterioration after hospitalization.