(723) Descriptive Analysis of Pediatric Rapid Response Team Activation at a Quaternary-Care Center

Introduction: Pediatric rapid response teams (RRTs) are utilized to identify and treat deteriorating patients. Since in-hospital mortality is relatively rare for children, critical deterioration events such as initiation of noninvasive ventilation, intubation, or use of vasopressor infusion within 12 hours have been proposed as proxies for decompensation. Despite identification of metrics, data surrounding the frequency and characteristics of these outcomes are lacking.

Methods: We utilized an internal RRT dashboard to identify RRTs for patients admitted to pediatric inpatient services from January 2019 through June 2023 at University of Michigan C.S. Mott Children’s Hospital. Our primary outcomes were transfer to intensive care and intubation within 6 hours of the RRT event. Statistical analysis was completed using chi-squared and Fisher’s exact tests, as appropriate.

Results: 2094 RRT events were analyzed. Overall, 1184 (56.5%) resulted in transfer to an ICU. When comparing cases of RRTs that resulted in transfer to the ICU compared to those that did not, 561 (47.4%) vs 345 (37.9%) had an RRT within 24 hours of admission (p < 0.01), 69 (5.8%) vs 73 (8.0%) had an RRT within 24 hours after transferring out of an ICU (p=0.05), 65 (5.5%) vs 47 (5.2%) had an RRT within 24 hours of an OR procedure (p=0.74), 358 (30.2%) vs 306 (33.6%) had an RRT after any OR procedure (p=0.1), 171 (14.4%) vs 76 (8.3%) had an RRT in the preceding 24 hours (p < 0.01), and 302 (25.5%) vs 265 (29.1%) had been admitted to an ICU earlier in the hospitalization (p=0.07). Intubation was more likely if an RRT occurred within 24 hours of admission (p=0.03), if the patient had received any OR procedure (p < 0.01), or if the patient had had been admitted to the ICU at any point earlier in the hospitalization (p=0.04).

Conclusions: Hospitalization characteristics such as time from admission and recent RRT activation were associated with transfer to an ICU, while prior ICU use or OR procedure were associated with intubation. These results suggest trajectory or severity of illness may predict escalations in care and can inform RRT improvement efforts.