Assessing the Impact of Emergency Transfers in Pediatric Cardiology

Abstract

Objective: Cardiopulmonary arrest is rare in pediatrics, but researchers have identified a proxy metric in emergency transfers (ETs) that has not been studied in pediatric cardiology. We aimed to assess the impact of ET on mortality, cardiac intensive care unit (CICU) length of stay (LOS), and hospitalization LOS in pediatric cardiology. We hypothesized that ETs have longer LOS and increased mortality.

Methods: This single-center, retrospective, propensity-score-matched cohort study assessed cardiology acute care unit to CICU transfers between February 1, 2019 and May 9, 2024. A propensity score with predetermined risk factors included age, diagnosis, high-risk diagnosis, surgical status, transfer reason, transfer shift/quarter, and pretransfer LOS. Transfers were classified by timing of qualifying intervention (intubation, vasoactive initiation, or large volume fluid bolus [≥60 mL/kg] administration): emergency if within 1 hour of transfer, urgent if within 1 to 12 hours of transfer, or otherwise no intervention. Outcomes included CICU LOS, posttransfer LOS, and in-hospital mortality.

Results: A total of 625 transfers were identified and 75 (11.9%) met criteria for ET. After successful matching, ETs demonstrated significantly increased in-hospital mortality (25% vs 10%; P = .001), CICU LOS (12.8 days vs 4.12 days; P < .001), and post-CICU transfer LOS (40.18 days vs 19.81 days; P = .012). Additionally, ETs had higher in-hospital mortality than both urgent (OR 3.6; 95% CI, 1.40-11; P = .011) and no intervention transfers (OR 5.3; 95% CI, 2.8-10; P < .001).

Conclusions: ETs are associated with increased LOS and mortality in pediatric cardiology. ETs are a valid proxy measure for clinical deterioration.