Carrie Daymont1, Fran Balamuth, Halden F Scott2, Christopher P Bonafide, Patrick W Brady3, Holly Depinet4, Elizabeth R Alpern5. 1. From the Departments of Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey. 2. Department of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO. 3. Divisions of Hospital Medicine. 4. Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 5. Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL.
Abstract
OBJECTIVE: The aim of this study was to identify emergency department (ED) heart rate (HR) values that identify children at elevated risk of ED revisit with admission. METHODS: We performed a retrospective cohort study of patients 0 to 18 years old discharged from a tertiary-care pediatric ED from January 2013 to December 2014. We created percentile curves for the last recorded HR for age using data from calendar year 2013 and used receiver operating characteristic (ROC) curves to characterize the performance of the percentiles for predicting ED revisit with admission within 72 hours. In a held-out validation data set (calendar year 2014 data), we evaluated test characteristics of last-recorded HR-for-age cut points identified as promising on the ROC curves, as well as those identifying the highest 5% and 1% of last recorded HRs for age. RESULTS: We evaluated 183,433 eligible ED visits. Last recorded HR for age had poor discrimination for predicting revisit with admission (area under the curve, 0.61; 95% confidence interval, 0.58-0.63). No promising cut points were identified on the ROC curves. Cut points identifying the highest 5% and 1% of last recorded HRs for age showed low sensitivity (10.1% and 2.5%) with numbers needed to evaluate of 62 and 50, respectively, to potentially prevent 1 revisit with admission. CONCLUSIONS: Last recorded ED HR discriminates poorly between children who are and are not at risk of revisit with admission in a pediatric ED. The use of single-parameter HR in isolation as an automated trigger for mandatory reevaluation prior to discharge may not improve revisit outcomes.
OBJECTIVE: The aim of this study was to identify emergency department (ED) heart rate (HR) values that identify children at elevated risk of ED revisit with admission. METHODS: We performed a retrospective cohort study of patients 0 to 18 years old discharged from a tertiary-care pediatric ED from January 2013 to December 2014. We created percentile curves for the last recorded HR for age using data from calendar year 2013 and used receiver operating characteristic (ROC) curves to characterize the performance of the percentiles for predicting ED revisit with admission within 72 hours. In a held-out validation data set (calendar year 2014 data), we evaluated test characteristics of last-recorded HR-for-age cut points identified as promising on the ROC curves, as well as those identifying the highest 5% and 1% of last recorded HRs for age. RESULTS: We evaluated 183,433 eligible ED visits. Last recorded HR for age had poor discrimination for predicting revisit with admission (area under the curve, 0.61; 95% confidence interval, 0.58-0.63). No promising cut points were identified on the ROC curves. Cut points identifying the highest 5% and 1% of last recorded HRs for age showed low sensitivity (10.1% and 2.5%) with numbers needed to evaluate of 62 and 50, respectively, to potentially prevent 1 revisit with admission. CONCLUSIONS: Last recorded ED HR discriminates poorly between children who are and are not at risk of revisit with admission in a pediatric ED. The use of single-parameter HR in isolation as an automated trigger for mandatory reevaluation prior to discharge may not improve revisit outcomes.
Authors: Weili Hong; Arul Earnest; Papia Sultana; Zhixiong Koh; Nur Shahidah; Marcus Eng Hock Ong Journal: Eur J Emerg Med Date: 2013-02 Impact factor: 2.799
Authors: Julius Cuong Pham; Thomas Dean Kirsch; Peter Michael Hill; Katherine DeRuggerio; Beatrice Hoffmann Journal: Acad Emerg Med Date: 2011-04 Impact factor: 3.451
Authors: Jameel Abualenain; William J Frohna; Mark Smith; Michael Pipkin; Cynthia Webb; David Milzman; Jesse M Pines Journal: J Emerg Med Date: 2013-01-24 Impact factor: 1.484
Authors: Oanh Kieu Nguyen; Anil N Makam; Christopher Clark; Song Zhang; Bin Xie; Ferdinand Velasco; Ruben Amarasingham; Ethan A Halm Journal: J Gen Intern Med Date: 2016-08-08 Impact factor: 5.128