Abstract
Background: Prior studies of Medical Emergency Teams (METs) in pediatric hospitals have shown inconsistent results in terms of their ability to improve outcomes. Whether the variable success is due to differential utilization of METs among hospitals is unknown. Methods: Within the Get With The Guidelines-Resuscitation Registry (GWTG-R), we identified children (age <18 years) with an in-hospital cardiac arrest (IHCA) on the general inpatient or telemetry floors from 2007 to 2014. In cases of IHCA where MET evaluation did not occur, we examined the frequency of “missed” opportunities for activation of the MET based upon the presence of one or more abnormal vital signs. We also examined the variability in utilization of the MET among those hospitals with at least ten cases of IHCA. Results: Of 215 children from 23 hospitals sustaining an IHCA, 48 (22.3%) had a preceding MET evaluation. Children with MET evaluation prior to IHCA were older (6.8 ± 6.5 vs. 3.1 ± 4.7, p < 0.001) and were more likely to have metabolic/electrolyte abnormalities (9/48 [18.8%] vs. 9/167 [5.4%], p=0.006), sepsis (8/48 [16.7%] vs. 8/167 [4.8%], p=0.01), or malignancy (11/48 [22.9%] vs. 9/167 [5.4%], p<0.001) at the time of their IHCA. Hospital utilization of the MET varied substantially (median 20%; inter-quartile range [IQR]: 3.4%-29.8%; range: 0%-36.4%). Among patients who did not have a MET called prior to their IHCA, 78/141 (55.3%) had at least one abnormal vital sign that should have triggered a MET. Conclusion: In a large, national registry, we found that the majority of pediatric IHCA cases are not preceded by a MET evaluation despite meeting criteria that should have triggered a MET. Improved utilization of the MET by all hospitals could lead to fewer pediatric IHCA and improved outcomes following pediatric IHCA.
Published Version
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