Characteristics of Children Who Deteriorate After Transport and Associated Preadmission Factors.

OBJECTIVE: The incidence of deterioration and associated characteristics are largely unknown for children transported for admission from referring emergency departments (EDs) to general inpatient units. This study describes this population and identifies associated preadmission characteristics. METHODS: This single-center cohort study included children ≤ 18 years old transferred from an ED and directly admitted to general inpatient units from 2016 to 2019. Deterioration was defined as 1 or more of the following occurring within 24 hours of admission: rapid response team activation, transfer to the intensive care unit (ICU), or cardiac or respiratory arrest. ICU transfer was the secondary outcome. Logistic regression was performed. RESULTS: One thousand nine hundred eighty-eight patients were included; the median age was 4.2 years, 53.9% were male, and 44.1% had respiratory diagnoses. Deterioration occurred in 135 (6.8%) children overall and in 10.1% of children with respiratory complaints. Deterioration was associated with ≥ 2 complex chronic conditions (adjusted odds ratio [aOR] = 2.09; 95% confidence interval [CI], 1.04-4.19) and a longer stabilization time (per 10 minutes) (aOR = 1.17; 95% CI, 1.01-1.36). ICU transfer was associated with ≥ 2 complex chronic conditions (aOR = 2.33; 95% CI, 1.13-4.80), supplemental oxygen via nasal cannula (aOR = 2.13; 95% CI, 1.18-3.85), and nebulizer treatment (aOR = 2.77; 95% CI, 1.21-6.35). CONCLUSION: Deterioration was experienced by 7% of children admitted to a general unit, with the majority having respiratory complaints. Transport teams should consider the potential for increased risk of deterioration among children with respiratory disease, multiple complex chronic conditions, and a nasal cannula or nebulizer therapy. The clinical significance of marginally longer stabilization times is unclear and warrants further investigation.

Targeted Temperature Management in Pediatric Central Nervous System Disease.

Acute central nervous system conditions due to hypoxic-ischemic encephalopathy, traumatic brain injury (TBI), status epilepticus, and central nervous system infection/inflammation, are a leading cause of death and disability in childhood. There is a critical need for effective neuroprotective therapies to improve outcome targeting distinct disease pathology. Fever, defined as patient temperature > 38°C, has been clearly shown to exacerbate brain injury. Therapeutic hypothermia (HT) is an intervention using targeted temperature management that has multiple mechanisms of action and robust evidence of efficacy in multiple experimental models of brain injury. Prospective clinical evidence for its neuroprotective efficacy exists in narrowly-defined populations with hypoxic-ischemic injury outside of the pediatric age range while trials comparing hypothermia to normothermia after TBI have failed to demonstrate a benefit on outcome but consistently demonstrate potential use in decreasing refractory intracranial pressure. Data in children from prospective, randomized controlled trials using different strategies of targeted temperature management for various outcomes are few but a large study examining HT versus controlled normothermia to improve neurological outcome in cardiac arrest is underway.