Layne Silver, MD,
MD
Cohen Children's Medical Center
New Hyde Park, NY
Disclosure information not submitted.
Matthew Taylor, MD
Pediatric Critical Care Attending Physician
Cohen Children's Medical Center
New Hyde Park, New York, United States
Disclosure information not submitted.
Sareen Shah, MD
Pediatric Critical Care Attending Physician
Cohen Children's Hospital
New Hyde Park, New York, United States
Disclosure information not submitted.
Title: Delayed Provider Recognition of Pediatric Acute Respiratory Distress Syndrome
INTRODUCTION/HYPOTHESIS: Failure to recognize Pediatric Acute Respiratory Distress Syndrome (PARDS) in a timely fashion may delay implementation of recommended management strategies. We hypothesize that delayed PARDS recognition will be associated with specific patient factors and will influence clinical management and outcomes.
Methods: A single center retrospective chart review was completed. All critical care attending progress notes of patients admitted to a 37-bed mixed PICU from 11/2016 through 04/2021 were queried for phrases including "PARDS", "ARDS", or "acute respiratory distress syndrome". The diagnosis was then confirmed by chart review. Oxygen saturation indices (OSI) were used to stratify mild, moderate, and severe PARDS. A delay in PARDS recognition was defined as a lack of provider documentation within a defined time window of 48 hours from first meeting PARDS criteria.
Results: 29 (28%) of 104 PARDS encounters were delayed in their recognition. Stratified rates of delay were 7/20 (35%) of mild PARDS, 14/32 (44%) of moderate PARDS, and 8/52 (15%) of severe PARDS. Patients were less likely to have a delay in PARDS recognition in the severe group as compared to the non-severe group (mild and moderate PARDS) (p=0.01). Infants were more likely to have delayed PARDS recognition (OR: 3.44, CI:1.38-8.59, p< 0.01), and children on vasoactive therapy were less likely (OR: 0.39, CI:0.16-0.95 p=0.04). Patients with delayed recognition spent on average 25.6% (CI:16.3%-34.9%) of the defined 48-hour time window at a lower PEEP than recommended by the ARDSnet PEEP/FiO2 Lower PEEP table, compared to 16.6% (CI:12%-21.3%) for the non-delayed group (p=0.07). Stratification analysis showed that severe PARDS patients who had delayed recognition spent more time at a lower PEEP than recommended (39.2% (CI:18.6%-59.8%) vs 20.6% (CI:13.5%-27.7%), p=0.04). Ventilator free days were 12.1 +/- 3.3 in the delayed group vs 13.7 +/- 2.4 in the non-delayed group (p=0.31).
Conclusions: Delay in PARDS identification occurs in approximately 1 of 4 patients in which PARDS is identified. Patients with non-severe PARDS, patients without vasoactive requirements, and infants were more likely to have delayed recognition. Prompt identification of PARDS may allow earlier initiation of proper management strategies.