Characteristics of Febrile Children Admitted to the ICU Following an Unscheduled ED Revisit Within 72 h, a Case–Control Study

Chiang, Chiao-Ching; Chen, Yu‐Lun; Lin, Yenn-Jiang; Cheng, Fu-Jen; Wu, Keng‐Liang; Chiu, I-Min

doi:10.3389/fped.2020.00411

Cited by 5 publications

(6 citation statements)

References 40 publications

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“…We calculated the SI and SIPA values from medical records documented in the research database for the included patients at the time of ED arrival and 24 h after admission. These values were then categorized as either abnormal (i.e., above the normal SI range or normal SIPA value for age range) or normal based on the normal range of vital signs in different age groups that were adopted in recent studies ( 17 , 25 , 27 ). We also calculated delta SI by subtracting the SI value at 24 h after admission from the SI value at admission.…”

Section: Methodsmentioning

confidence: 99%

“…There is a paucity of data on this subject in non-traumatic pediatric patients. One study conducted in 2020 indicated that febrile children with elevated SIPA values on the initial emergency department (ED) visit were associated with ICU admission following an unscheduled ED revisit within 72 h ( 27 ). Considering that the conclusions of most studies on SIPA were confined to trauma patients, this study attempted to expand the use of this tool to include additional pediatric populations.…”

Section: Introductionmentioning

confidence: 99%

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Shock Index, Pediatric Age-Adjusted Predicts Morbidity and Mortality in Children Admitted to the Intensive Care Unit

Huang

Yang

et al. 2021

Front. Pediatr.

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Background: The shock index, pediatric age-adjusted (SIPA), defined as the maximum normal heart rate divided by the minimum normal systolic blood pressure by age, can help predict the risk of morbidity and mortality after pediatric trauma. This study investigated whether the SIPA can be used as an early index of prognosis for non-traumatic children visiting the pediatric emergency department (ED) and were directly admitted to the intensive care unit (ICU). We hypothesized that an increase in SIPA values in the first 24 h of ICU admission would correlate with mortality and adverse outcomes.Methods: This multicenter retrospective study enrolled non-traumatic patients aged 1–17 years who presented to the pediatric ED and were directly admitted to the ICU from January 1, 2016, to December 31, 2018, in Taiwan. The SIPA value was calculated at the time of arrival at the ED and 24 h after ICU admission. Cutoffs included SIPA values >1.2 (patient age: 1–6), >1.0 (patient age: 7–12), and >0.9 (patient age: 12–17). The utility of the SIPA and the trends in the SIPA during the first 24 h of ICU admission were analyzed to predict outcomes.Results: In total, 1,732 patients were included. Of these, 1,050 (60.6%) were under 6 years old, and the median Pediatric Risk of Mortality score was 7 (5–10). In total, 4.7% of the patients died, 12.9% received mechanical ventilator (MV) support, and 11.1% received inotropic support. The SIPA value at 24 h after admission was associated with increased mortality [odds ratio (OR): 4.366, 95% confidence interval (CI): 2.392–7.969, p < 0.001], MV support (OR: 1.826, 95% CI: 1.322–2.521, p < 0.001), inotropic support (OR: 2.306, 95% CI: 1.599–3.326, p < 0.001), and a long hospital length of stay (HLOS) (2.903 days, 95% CI: 1.734–4.271, p < 0.001). Persistent abnormal SIPA value was associated with increased mortality (OR: 2.799, 95% CI: 1.566–5.001, p = 0.001), MV support (OR: 1.457, 95% CI: 1.015–2.092, p = 0.041), inotropic support (OR: 1.875, 95% CI: 1.287–2.833, p = 0.001), and a long HLOS (3.2 days, 95% CI: 1.9–4.6, p < 0.001). Patients with abnormal to normal SIPA values were associated with decreased mortality (OR: 0.258, 95% CI: 0.106–0.627, p = 0.003), while patients with normal to abnormal SIPA values were associated with increased mortality (OR: 3.055, 95% CI: 1.472–5.930, p = 0.002).Conclusions: In non-traumatic children admitted to the ICU from the ED, increased SIPA values at 24 h after ICU admission predicted high mortality and bad outcomes. Monitoring the trends in the SIPA could help with prognostication and optimize early management.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Shock Index, Pediatric Age-Adjusted Predicts Morbidity and Mortality in Children Admitted to the Intensive Care Unit

Huang

Yang

et al. 2021

Front. Pediatr.

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“…Several studies have sought to identify the risk factors for return ED visits in the general ED population [13][14][15][16][17]. Recently, several revisit prediction models have been developed for children and elderly patients with specific Healthcare 2021, 9, 1470 2 of 10 diseases, such as urinary tract infection and asthma [18][19][20][21][22][23]. It is imperative for emergency physicians to identify the risk of revisiting before discharge among patients presenting with NSAP, one of the most common complaints associated with return visits.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Early Return Visits to the Emergency Department in Patients Presenting with Nonspecific Abdominal Pain and the Use of Computed Tomography Scan

et al. 2021

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Over a quarter of patients presenting with abdominal pain at emergency departments (EDs) are diagnosed with nonspecific abdominal pain (NSAP) at discharge. This study investigated the risk factors associated with return ED visits in Taiwanese patients with NSAP after discharge. We divided patients into two groups: the study group comprising patients with ED revisits after the index ED visit, and the control group comprising patients without revisits. During the study period, 10,341 patients discharged with the impression of NSAP after ED management. A regression analysis found that older age (OR [95%CI]: 1.007 [1.003–1.011], p = 0.004), male sex (OR [95%CI]: 1.307 [1.036–1.650], p = 0.024), and use of NSAIDs (OR [95%CI]: 1.563 [1.219–2.003], p < 0.001) and opioids (OR [95%CI]: 2.213 [1.643–2.930], p < 0.001) during the index visit were associated with increased return ED visits. Computed tomography (CT) scans (OR [95%CI]: 0.605 [0.390–0.937], p = 0.021) were associated with decreased ED returns, especially for those who were older than 60, who had an underlying disease, or who required pain control during the index ED visit.

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“…Return visits to the ED are stressful for the physician and constitute a worldwide phenomenon that may be partially preventable. Studies have described short-term revisit after hospital discharge exploring predicting factors, 2,3,5,10 but only a few studies have investigated which factors could be useful in predicting outcomes of a second visit 11,12 . In this cohort of children attending a PED with high levels of CRP (≥150 mg/L) at the initial visit, the level of CRP was not useful in predicting clinical outcomes of children who returned for a second visit within 7 days.…”

Section: Discussionmentioning

confidence: 85%

C-Reactive Protein and the Outcome of a Pediatric Emergency Department 7 Days Revisit

et al. 2022

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BackgroundPediatric emergency department (PED) return visits represent an important quality of care metric and constitute a patient-centered outcome. C-reactive protein (CRP) is an inflammatory biomarker that is commonly used as screening tool in the PED. In this study, we assessed the clinical outcomes of children whose levels of CRP are 150 mg/L or higher at the initial PED visit and if such levels could be useful in predicting outcomes at a second PED visit.MethodsA historical cohort study of all patients who visited the PED between July 2007 and June 2017 and had a CRP value of 150 mg/L or greater in the setting of a febrile illness. Data of patients with a return visit to the PED within 7 days were assessed for an association between laboratory values, diagnosis and clinical outcome.ResultsOne hundred thirty-six index visits were included in this study. One hundred fifteen (84.6%) of the revisits were discharged after their second visit, and 21 (15.4%) were admitted to the inpatient unit. Admitted patients did not differ from patients who were discharged home in diagnosis and CRP levels, but a difference in white blood cell and absolute neutrophil counts was observed.ConclusionsThe intensity of the inflammatory response, as expressed by the high concentrations of CRP in children, does not seem to predict the outcome at a repeat PED visit within 7 days.

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Characteristics of Febrile Children Admitted to the ICU Following an Unscheduled ED Revisit Within 72 h, a Case–Control Study

Cited by 5 publications

References 40 publications

Shock Index, Pediatric Age-Adjusted Predicts Morbidity and Mortality in Children Admitted to the Intensive Care Unit

Shock Index, Pediatric Age-Adjusted Predicts Morbidity and Mortality in Children Admitted to the Intensive Care Unit

Risk Factors for Early Return Visits to the Emergency Department in Patients Presenting with Nonspecific Abdominal Pain and the Use of Computed Tomography Scan

C-Reactive Protein and the Outcome of a Pediatric Emergency Department 7 Days Revisit

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