Black pediatric patients were significantly less likely to be transferred to the ICU within 12 hours of a rapid response team event (OR 0.76; 95% CI 0.59-0.97).
Are patient demographics and social determinants of health associated with critical deterioration events or ICU transfer following a Rapid Response Team event in hospitalized children?
In a pediatric cohort, social determinants of health were not associated with increased risk of critical deterioration following a rapid response event, though Black patients had lower odds of ICU transfer.
Absolute Event Rate: 0% vs 0%
Introduction: Rapid Response Teams (RRT) are used to assess and treat patients on the general care floor to prevent poor outcomes including critical deterioration events (CDE). Limited data demonstrate an association between social determinants of health (SDH) with CDE. We sought to determine the association of patient demographics and SDH characteristics with CDE and intensive care unit (ICU) transfer following an RRT event at our institution. Methods: Using our electronic medical record (EMR), we identified all hospital encounters of children ages 0-21 years with an RRT from January 2019 to June 2024 at a single center academic institution in Michigan. Patients were eligible to have an RRT event if they were hospitalized in any unit outside of an ICU or wellborn nursery. Our primary outcomes were any CDE or transfer to the ICU within 12 hours of RRT. CDE included any vasoactive medication initiation, new noninvasive mechanical ventilation, endotracheal intubation, cardiopulmonary resuscitation, or death. Covariates identified in the EMR included race, ethnicity, Area Deprivation Index (ADI; higher ADI means a more disadvantaged area), preferred language, age, and sex. We used multivariable logistic regression to estimate the odds of CDE, accounting for repeated hospitalizations using generalized estimating equations (GEE). Results: We identified 1,992 hospitalizations with RRT events of whom 57.3% (n=1,142) were male, with a median of 3.0 years (IQR 0.0-12.0). Overall, 18.3% (n=364) of patients identified as Black, 8.6% (n=172) as Hispanic, and 4.5% (n=90) preferred a non-English language. The median state-level ADI was 5 (IQR: 2-8). 26.5% (n=527) had a CDE and 58.6% (n=1,167) were transferred to an ICU. No SDH was significantly associated with increased odds of a CDE. Black patients were less likely to be transferred to the ICU 12 hours after a RRT (Odds ratio OR=0.76; 95%CI 0.59-0.97, p=0.03). Conclusions: Patients in our cohort from diverse groups, disadvantaged areas, or who preferred a non-English language were not at increased risk for CDE or ICU transfer following an RRT. Investigation is warranted to understand the causes and implications of lower transfer to the ICU following an RRT among Black patients.
Alvarez et al. (Sun,) reported a other. Black pediatric patients were significantly less likely to be transferred to the ICU within 12 hours of a rapid response team event (OR 0.76; 95% CI 0.59-0.97).