Abstract
Background
Supraventricular tachycardia (SVT) is a relatively frequent diagnosis in the pediatric emergency department (ED). However, there are no consensus guidelines for ED disposition, and there are limited data on ED outcomes. Better understanding of those who are admitted or have antiarrhythmic medication changes may avoid potentially unnecessary transfers or admissions. Our objective was to identify patient factors associated with discharge from the emergency department without medication initiation or modification after management of SVT in the pediatric ED.
Design/Methods
A retrospective review of children aged 0–18 years seen in the emergency department for SVT was conducted using electronic medical record data over a ten-year period at a single academic tertiary children’s hospital. Patients with congenital cardiac disease or prior cardiac surgeries were excluded. Multivariable logistic regression analysis was used to determine association between patient factors of interest and the primary outcome of admission and secondary outcome of change to antiarrhythmic medications.
Results
We analyzed 197 patients encounters. The mean age was 7 years. Of these 104 (52.8%) were admitted to the hospital or discharged with antiarrhythmic medication changes. This primary outcome was associated with younger age (aOR 0.77, 95% CI 0.67–0.86), history of pre-excitation (aOR 5.82, 95% CI 2.01–18.8), intercurrent illness (aOR 3.75, 95% CI 1.27–12.1), number of adenosine doses prior to arrival (aOR 5.45, 95% CI 1.55–22.3), and in-person cardiology consultation (aOR 6.42, 95% CI 2.43–19.4).
Conclusions
Nearly half of children treated in a pediatric ED for SVT are discharged without changes in medications. We identified patient factors associated with hospital admission or antiarrhythmic medication changes. These factors represent high value care and can be assessed when considering transfer from a referring facility. Risk stratification using these patient characteristics may reduce potentially avoidable transfers and admissions.
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KS wrote the first draft of the manuscript. KS, MM, GA, and JD provided study conception and design. JT provided statistical design, ran statistics, and created all tables. KS and CM provided chart review and extraction and manually screened charts for inclusion. All authors reviewed the manuscript and provided substantive feedback that were incorporated into the final product.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Kyle Schmucker, Caroline Morris, Jennifer Dunnick, and Robert Tisherman. The first draft of the manuscript was written by Kyle Schmucker and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of The University of Pittsburgh approved this study.
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Schmucker, K.A., Morris, C.S., Tisherman, R.T. et al. Patient Characteristics Associated with Hospital Admission or Antiarrhythmic Medication Changes After Emergency Department Evaluation of Supraventricular Tachycardia. Pediatr Cardiol 44, 1710–1715 (2023). https://doi.org/10.1007/s00246-023-03257-z
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DOI: https://doi.org/10.1007/s00246-023-03257-z