Danielle Guffey, MS
Mrs.
Baylor College of Medicine, United States
Disclosure information not submitted.
Natasha Afonso, MD, MPH
Assistant Professor
Texas Children's Hospital and Baylor College of Medicine, United States
Disclosure information not submitted.
Title: Pediatric Rapid Response Event Outcomes According to Patient Race/Ethnicity and Language
Introduction: While many studies have evaluated patient and system factors that influence rapid response event (RRE) outcomes, few have included the influence of social factors. The goal of this study is to evaluate the association between race, ethnicity, and patient preferred language with characteristics of RRE and critical deterioration events (CDE), defined as escalation in vasoactive or respiratory support within 12 hours of transfer to the ICU.
Methods: Retrospective cohort study of RRE in hospitalized children from 2016-2019 was performed with data from a RRE database, Pediatric Health Information System database, and the electronic medical record. Primary outcomes were CDE and mortality. Patient and RRE characteristics and outcomes were summarized using frequency with percentage and compared using ANOVA and Wilcoxon rank sum test. Odds of mortality and CDE are assessed using unadjusted logistic regression.
Results: Of the 3301 patients with a RRE during their index admission, 1187 (36%) had a CDE. In unadjusted regression, there were no differences in rates of CDE based on racial and ethnic groups or patient preferred language. Hispanic patients had 1.54 times higher odds of mortality (CI 1.07-2.22, p=0.02) compared to non-Hispanic patients, but this difference was not seen in patients with CDE. Patients with CDE demonstrated no difference in RRE triggers or interventions among racial and ethnic groups. Respiratory triggers varied among groups (87.5% of speakers of Asian or other languages, 81.8% of English speakers, 79.9% of Spanish speakers, and 42.9% of Arabic speakers [p=0.02]). Despite these differences, there was no significant difference in respiratory interventions. Neurologic triggers also varied (50.0% of Arabic speakers, 37.5% of other languages, 18.9% of English speakers, 15.1% of Spanish speakers, and no speakers of Asian languages [p=0.01]). There were no differences in cardiac or multiple triggers or in mortality based on language following a CDE.
Conclusions: Hispanic patients have higher mortality after RRE when compared to non-Hispanic patients, and there is variability among RRE triggers and interventions based on patient language. These findings highlight the need for continued research, advocacy, and interventions to achieve health equity across racial and ethnic groups.