Abstract
Children with single ventricle physiology (SV) are at high risk of in-hospital morbidity and mortality. Identifying children at risk for deterioration may allow for earlier escalation of care and subsequently decreased mortality.
We conducted a retrospective chart review of all admissions to the pediatric cardiology non-ICU service from 2014 to 2018 for children < 18 years old. We defined clinical deterioration as unplanned transfer to the ICU or inpatient mortality. We selected children with SV by diagnosis codes and defined infants as children < 1 year old. We compared demographic, vital sign, and lab values between infants with and without a deterioration event. We evaluated vital sign and medical therapy changes before deterioration events.
Among infants with SV (129 deterioration events over 225 admissions, overall 25% with hypoplastic left heart syndrome), those who deteriorated were younger (p = 0.001), had lower baseline oxygen saturation (p = 0.022), and higher baseline respiratory rate (p = 0.022), heart rate (p = 0.023), and hematocrit (p = 0.008). Median Duke Pediatric Early Warning Score increased prior to deterioration (p < 0.001). Deterioration was associated with administration of additional oxygen support (p = 0.012), a fluid bolus (p < 0.001), antibiotics (p < 0.001), vasopressor support (p = 0.009), and red blood cell transfusion (p < 0.001).
Infants with SV are at high risk for deterioration. Integrating baseline and dynamic patient data from the electronic health record to identify the highest risk patients may allow for earlier detection and intervention to prevent clinical deterioration.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Fixler DE et al (2010) Mortality in first 5 years in infants with functional single ventricle born in Texas, 1996 to 2003. Circulation 121(5):644–650. https://doi.org/10.1161/CIRCULATIONAHA.109.881904
Ahmed H et al (2020) Development of a validated risk score for interstage death or transplant after stage I palliation for single-ventricle heart disease. J Thorac Cardiovasc Surg 160(4):1021–1030. https://doi.org/10.1016/j.jtcvs.2019.11.001
Mascio CE et al (2019) Thirty years and 1663 consecutive Norwood procedures: has survival plateaued? J Thorac Cardiovasc Surg 158(1):220–229. https://doi.org/10.1016/j.jtcvs.2018.12.117
Penk JS et al (2015) Unplanned admissions to a pediatric cardiac critical care unit: a review of 2 years’ experience. Pediatr Crit Care Med 16(2):155–160. https://doi.org/10.1097/PCC.0000000000000316
Bavare AC et al (2017) Acute Decompensation in Pediatric Cardiac Patients: outcomes after Rapid Response events. Pediatr Crit Care Med 18(5):414–419. https://doi.org/10.1097/PCC.0000000000001117
Miles AH, Spaeder MC, Stockwell DC (2016) Unplanned ICU transfers from Inpatient units: examining the prevalence and preventability of adverse events Associated with ICU transfer in Pediatrics. J Pediatr Intensive Care 5(1):21–27. https://doi.org/10.1055/s-0035-1568150
Endacott R et al (2007) Recognition and communication of patient deterioration in a regional hospital: a multi-methods study. Aust Crit Care 20(3):100–105. https://doi.org/10.1016/j.aucc.2007.05.002
Lambert V et al (2017) Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review. BMJ Open 7(3):e. https://doi.org/10.1136/bmjopen-2016-014497
Rusin CG et al (2016) Prediction of imminent, severe deterioration of children with parallel circulations using real-time processing of physiologic data. J Thorac Cardiovasc Surg 152(1):171–177. https://doi.org/10.1016/j.jtcvs.2016.03.083
McLellan MC, Gauvreau K, Connor JA (2014) Validation of the Cardiac Children’s hospital early warning score: an early warning Scoring Tool to prevent cardiopulmonary arrests in children with Heart Disease. Congenit Heart Dis 9:194–202. https://doi.org/10.1111/chd.12132
King G et al (2022) Natural and modified history of atrioventricular valve regurgitation in patients with Fontan circulation. J Am Coll Cardiol 79(18):1832–1845. https://doi.org/10.1016/j.jacc.2022.02.022
Haga T et al (2022) Characteristics of In-Hospital patients with congenital heart Disease requiring Rapid Response System Activations: a japanese database study. Congenit Heart Dis 17(1):31–43. https://doi.org/10.32604/chd.2022.017407
Olive MK, Owens GE (2018) Current monitoring and innovative predictive modeling to improve care in the pediatric cardiac intensive care unit. Transl Pediatr 7(2):120–128. https://doi.org/10.21037/tp.2018.04.03
Rusin CG et al (2021) Automated prediction of cardiorespiratory deterioration in patients with single ventricle. J Am Coll Cardiol 77(25):3184–3192. https://doi.org/10.1016/j.jacc.2021.04.072
Garcia-Canadilla P et al (2022) Machine learning-based Systems for the anticipation of adverse events after Pediatric Cardiac surgery. Front Pediatr 10. https://doi.org/10.3389/fped.2022.930913
Ruiz VM et al (2022) Early prediction of clinical deterioration using data-driven machine-learning modeling of electronic health records. J Thorac Cardiovasc Surg 164(1):211–222. https://doi.org/10.1016/j.jtcvs.2021.10.060
Ruiz VM et al (2019) Early prediction of critical events for infants with single-ventricle physiology in critical care using routinely collected data. J Thorac Cardiovasc Surg 158(1):234–243. https://doi.org/10.1016/j.jtcvs.2019.01.130
Kim SY et al (2019) A deep learning model for real-time mortality prediction in critically ill children. Crit Care 23(1):279. https://doi.org/10.1186/s13054-019-2561-z
Alten J et al (2022) Preventing Cardiac arrest in the Pediatric Cardiac Intensive Care Unit through Multicenter collaboration. JAMA Pediatr 176(10):1027–1036. https://doi.org/10.1001/jamapediatrics.2022.2238
DiBardino DJ et al (2012) Effect of sex and race on outcome in patients undergoing congenital heart surgery: an analysis of the society of thoracic surgeons congenital heart surgery database. Ann Thorac Surg 94(6) 2054-9; discussion 2059. https://doi.org/10.1016/j.athoracsur.2012.05.124
Benavidez OJ et al (2007) Complications and risk factors for mortality during congenital heart surgery admissions. Ann Thorac Surg 84(1):147–155. https://doi.org/10.1016/j.athoracsur.2007.02.048
Williamson CG et al (2023) Insurance-based disparities in congenital Cardiac Operations in the era of the Affordable Care Act. Pediatr Cardiol. https://doi.org/10.1007/s00246-023-03136-7
Santana S et al (2022) Adverse maternal fetal environment partially mediates disparate outcomes in non-white neonates with major congenital heart disease. J Pediatr. https://doi.org/10.1016/j.jpeds.2022.06.036
Gardner MM et al (2019) Association of a Home Monitoring Program with Interstage and Stage 2 outcomes. J Am Heart Assoc 8(10). https://doi.org/10.1161/JAHA.118.010783
Tabbutt S et al (2012) Risk factors for hospital morbidity and mortality after the Norwood procedure: a report from the Pediatric Heart Network single ventricle Reconstruction trial. J Thorac Cardiovasc Surg 144(4):882–895. https://doi.org/10.1016/j.jtcvs.2012.05.019
Schwartz SM et al (2014) Risk factors for prolonged length of stay after the stage 2 procedure in the single-ventricle reconstruction trial. J Thorac Cardiovasc Surg 147(6):1791–1798. https://doi.org/10.1016/j.jtcvs.2013.07.063
Chapman SM et al (2016) Systematic review of paediatric track and trigger systems for hospitalised children. Resuscitation 109:87–109. https://doi.org/10.1016/j.resuscitation.2016.07.230
Trubey R et al (2019) Validity and effectiveness of paediatric early warning systems and track and trigger tools for identifying and reducing clinical deterioration in hospitalised children: a systematic review. BMJ Open 9(5):e. https://doi.org/10.1136/bmjopen-2018-022105
Author information
Authors and Affiliations
Contributions
All authors made substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data. H.F. and G.L. drafted the work, all authors revised it critically for important intellectual content. All authors approved the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Corresponding author
Ethics declarations
Competing Interests
The authors declare no competing interests.
Conflict of Interest
The authors have no financial disclosures or conflicts of interest to report.
IRB Approval
The study was approved by the Duke University Medical Center Institutional Review Board (Pro00102839).
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic Supplementary Material
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Foote, H.P., Lee, G.S., Gonzalez, C.D. et al. Risk of in-hospital Deterioration for Children with Single Ventricle Physiology. Pediatr Cardiol 44, 1293–1301 (2023). https://doi.org/10.1007/s00246-023-03191-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-023-03191-0