Care of Children with Supraventricular Tachycardia in the Emergency Department

Abstract

Prior studies have characterized children with supraventricular tachycardia (SVT) in inpatient settings, however there is a paucity of data regarding pediatric SVT in the Emergency Department (ED) setting. We sought to describe pediatric ED visits for SVT and assess whether variability exists in care. We performed a cross-sectional study of ED visits for SVT among children < 18 years old from 2010 to 2017 at 33 pediatric hospitals. Visits were included if made for a primary International Disease Classification Ninth or Tenth Revision diagnosis code for SVT and intravenous (IV) adenosine was given on the initial or 2nd hospital day. We evaluated factors associated with hospital admission using multivariate logistic regression and described variability in frequency of rate of hospitalization, second-line IV antiarrhythmic medication usage, and diagnostic testing across sites. We included 2329 ED visits made by 1738 children and the median patient age was 6.3 years (IQR 1.5–11.9). There were 2 deaths (0.1% of visits). Marked variability existed between centers in rates of admission to the hospital (range 17–85%) and ICU (range 4–60%). Factors associated with admission included: younger age, male sex and presence of comorbid conditions. A second IV antiarrhythmic agent was used in 17% of visits (range 4–41% across hospitals). There was variability in rates of diagnostic testing between centers [chest x-ray (range 10–47%), complete blood count (range 10–72%), electrolytes (range 22–86%), echocardiography (range 3–68%)]. Management of SVT is variable across pediatric hospitals, suggesting an opportunity for standardization in care.