Faculty Opinions recommendation of Early prognostic value of the medical emergency team calling criteria in patients admitted to intensive care from the emergency department.

Introduction: To determine the association between both abnormal individual vital signs and abnormal vital sign groups in the emergency department, and undesirable patient outcomes: hospital admission, medical emergency team calls and death. Method: We undertook a prospective cohort study in a tertiary referral emergency department (February–May 2015). Vital signs were collected prospectively in the emergency department and undesirable outcomes from the medical records. The primary outcomes were undesirable outcomes for individual vital signs (multivariate logistic regression) and vital sign groups (univariate analyses). Results: Data from 1438 patients were analysed. Admission was associated with tachycardia, tachypnoea, fever, ≥1 abnormal vital sign on admission to the emergency department, ≥1 abnormal vital sign at any time in the emergency department, a persistently abnormal vital sign, and vital signs consistent with both sepsis (tachycardia/hypotension/abnormal temperature) and pneumonia (tachypnoea/fever) (p < 0.05). Medical emergency team calls were associated with tachycardia, tachypnoea, ≥1 abnormal vital sign on admission (odds ratio: 2.3, 95% confidence interval: 1.4–3.8), ≥2 abnormal vital signs at any time (odds ratio: 2.4, 95% confidence interval: 1.2–4.7), and a persistently abnormal vital sign (odds ratio: 2.7, 95% confidence interval: 1.6–4.6). Death was associated with Glasgow Coma Score ≤13 (odds ratio: 6.3, 95% confidence interval: 2.5–16.0), ≥1 abnormal vital sign on admission (odds ratio: 2.6, 95% confidence interval: 1.2–5.6), ≥2 abnormal vital signs at any time (odds ratio: 6.4, 95% confidence interval: 1.4–29.5), a persistently abnormal vital sign (odds ratio: 4.3, 95% confidence interval: 2.0–9.0), and vital signs consistent with pneumonia (odds ratio: 5.3, 95% confidence interval: 1.9–14.8). Conclusion: Abnormal vital sign groups are generally superior to individual vital signs in predicting undesirable outcomes. They could inform best practice management, emergency department disposition, and communication with the patient and family.

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Rates of in‐hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team

The Medical Journal of Australia ◽

10.5694/j.1326-5377.2000.tb125627.x ◽

2000 ◽

Vol 173 (5) ◽

pp. 236-240 ◽

Cited By ~ 223

Author(s):

Peter J Bristow ◽

Ken M HIiiman ◽

Kathy Daffum ◽

Sandra L Norman ◽

Gillian F Bishop ◽

...

Keyword(s):

Intensive Care ◽

Medical Emergency Team ◽

Medical Emergency ◽

Emergency Team

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Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit*

Pediatric Critical Care Medicine ◽

10.1097/01.pcc.0000262947.72442.ea ◽

2007 ◽

Vol 8 (3) ◽

pp. 236-246 ◽

Cited By ~ 141

Author(s):

Richard J. Brilli ◽

Rosemary Gibson ◽

Joseph W. Luria ◽

T Arthur Wheeler ◽

Julie Shaw ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Teaching Hospital ◽

Medical Emergency Team ◽

Medical Emergency ◽

Emergency Team

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Prognostic value of the calling criteria in patients receiving a medical emergency team review

Resuscitation ◽

10.1016/j.resuscitation.2010.01.025 ◽

2010 ◽

Vol 81 (6) ◽

pp. 667-670 ◽

Cited By ~ 27

Author(s):

Márcio Manozzo Boniatti ◽

Neusa Azzolini ◽

Deisi Letícia Oliveira da Fonseca ◽

Berenice Severino Pinto Ribeiro ◽

Vanessa Martins de Oliveira ◽

...

Keyword(s):

Prognostic Value ◽

Medical Emergency Team ◽

Medical Emergency ◽

Emergency Team

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Is postoperative intensive care unit admission a prerequisite for elective craniotomy?

Journal of Neurosurgery ◽

10.3171/2011.8.jns11105 ◽

2011 ◽

Vol 115 (6) ◽

pp. 1236-1241 ◽

Cited By ~ 43

Author(s):

John Q. H. Bui ◽

Rajith L. Mendis ◽

James M. van Gelder ◽

Mark M. P. Sheridan ◽

Kylie M. Wright ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Loss ◽

Medical Emergency Team ◽

Medical Emergency ◽

Safe Alternative ◽

Emergency Team ◽

Icu Admission ◽

Postoperative Intensive Care ◽

Postoperative Intensive Care Unit

Object Routine postoperative admission to the intensive care unit (ICU) is often considered a necessity in the treatment of patients following elective craniotomy but may strain already limited resources and is of unproven benefit. In this study the authors investigated whether routine postoperative admission to a regular stepdown ward is a safe alternative. Methods Three hundred ninety-four consecutive patients who had undergone elective craniotomy over 54 months at a single institution were retrospectively analyzed. Indications for craniotomy included tumor (257 patients) and transsphenoidal (63 patients), vascular (31 patients), ventriculostomy (22 patients), developmental (13 patients), and base of skull conditions (8 patients). Recorded data included age, operation, reason for ICU admission, medical emergency team (MET) calls, in-hospital mortality, and postoperative duration of stay. Results Three hundred forty-three patients were admitted to the regular ward after elective craniotomy, whereas there were 43 planned and 8 unplanned ICU admissions. The most common reasons for planned ICU admissions were anticipated lengthy operations (42%) and anesthetic risks (40%); causes for unplanned ICU admissions were mainly unexpected slow neurological recovery and extensive intraoperative blood loss. Of the 343 regular ward admissions, 10 (3%) required a MET call; only 3 of these MET calls occurred within the first 48 postoperative hours and did not lead to an ICU admission. The overall mortality rate in the investigated cohort was 1%, with no fatalities in patients admitted to the normal ward postoperatively. Conclusions Routine ward admission for patients undergoing elective craniotomies with selective ICU admission appears safe; however, approximately 2% of patients may require a direct postoperative unplanned ICU admission. Patients with anticipated long operation times, extensive blood loss, and high anesthetic risks should be selected for postoperative ICU admission, but further study is needed to determine the preoperative factors that can aid in identifying and caring for these groups of patients.

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Abstract 346: Cardiac Diagnoses and Initial Presentation to the Emergency Department May Be Associated With Hospital Mortality Among Hospitalized Pediatric Patients Who Experience Medical Emergency Team Events

Circulation ◽

10.1161/circ.140.suppl_2.346 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Rebecca J Piasecki ◽

Mona N Bahouth ◽

Chakra Budhathoki ◽

Heather M Newton ◽

Jordan M Duval-Arnould ◽

...

Keyword(s):

Emergency Department ◽

Hospital Mortality ◽

Pediatric Patients ◽

Medical Emergency Team ◽

Patient Characteristics ◽

Medical Emergency ◽

Admission Diagnosis ◽

Emergency Department Care ◽

Emergency Team ◽

Levels Of Care

Introduction: There is a paucity of data regarding the association of pediatric patient characteristics with hospital mortality and transfer to higher levels of care following medical emergency team (MET) events. Objective: To explore associations of patient characteristics with hospital mortality and transfer to higher levels of care among pediatric patients who experienced a MET event during an admission. Methods: This retrospective observational study included data from patients aged ≤17 years admitted to an urban, tertiary hospital who experienced a MET event between 2014 and 2017. Data specific to the initial MET event for a patient were included for analysis. Multiple logistic regression models were used to test associations between patient characteristics (age, race, sex, ethnicity, timing of MET event, primary admission diagnosis, receiving care on specialized units) and each outcome separately. Results: Of the 366 patients eligible for inclusion, 11% (41 of 366) experienced hospital mortality, and 59% (216 of 366) were transferred to higher levels of care following MET events. Hospital mortality was lower among those who received emergency department care within 24 hours before the MET event compared to patients who did not (OR=0.17; 95% CI=0.04-0.82). Hospital mortality was higher among those with cardiac-related primary admission diagnoses compared to patients with noncardiac-related diagnoses (OR=3.44; 95% CI=1.04-11.39), and among those of unknown race compared to white patients (OR=3.14; 95% CI=1.17-8.48). No patient characteristics were associated with transfers to higher levels of care. Conclusions: While MET events may cause concern about failures to triage patients to appropriate levels of care upon admission, we observed that patients admitted from the emergency department within 24 hours before their MET event were more likely to survive to discharge. Higher hospital mortality following MET events was observed among patients with cardiac diagnoses and those of unknown race; more research is needed to understand how processes and documentation of care are related to these patients. Further study of how these characteristics and other potential confounding factors are associated with MET events and outcomes is warranted.

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