Impact of Pediatric Emergency Team (PET) on PICU transfers from wards and overall mortality
Abstract
A high index of suspicion is needed in pediatric patients with neurological symptoms being the sole presenting manifestation, to diagnose infection with the Human Immunodeficiency Virus (HIV). This is a write up of two such cases who were admitted to the pediatric intensive care unit with neurological manifestations. A 6 year old previously healthy child, who initially presented with intermittent drowsiness and fluctuation in blood pressure, later during hospital stay, developed progressive motor, cognitive, visual and language difficulties. Investigations revealed the child to be HIV positive and magnetic resonance imaging (MRI) findings were consistent with progressive multifocal leucoencephalopathy. A 12 yr old child had stroke initially (for which extensive work up had been done) and later, after 8 months presented with the same complaints along with severe pneumonia. He succumbed to severe opportunistic infections. That he was HIV positive, had not been detected during the first admission as left sided weaknesswas the only presenting manifestation.Key words: Pediatrics, rapid response team, pediatric emergency team, medical emergency response teamReferences
1. Robert E O'Connor .Cardiopulmonary Resuscitation in Infants and Children
2. Buist MD, Jarmolowski E, Burton PR, et al. Recognising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care. Med J Aust 1999; 171: 22-25.
3. Franklin C, Mathew J. Developing strategies to prevent inhospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event. Crit Care Med 1994; 22:244-247.
4. Shein RMH, Hazday N, Pena M, et al. Clinical antecedents to in-hospital cardiopulmonary arrest.Chest 1990; 98: 1388-1392.
5.James Tibballs, MB, BS, MD, BMedSc, MEd, MBA, MH lth & Med Law, Grad Dip Arts, FANZCA, FJFICM, FACLM; Sharon Kinney, RN, MN, PhD Reduction of hospital mortality and of preventable cardiac arrest and death on introduction of a pediatric medical emergency team. Pediatr Crit Care Med 2009; 10:306 –312).
6. Lee A, Bishop G, Hillman KM, Daffurn K: The Medical Emergency Team. Anaesth Intensive Care 1995, 23:183-186
7. D. R. Goldhill et al. Identifying and managing seriously ill ward patients. Anaesthesia, 1999, 54, pages 853±860
8. Tibballs J, Kinney S, Duke T, et al: Reduction of paediatric in-patient cardiac arrest and death with a medical emergency team: Preliminary results. Arch Dis Child 2005; 90: 1148–1152
9. Brilli RJ Gibson R Luria JW et al. Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit. Pediatr Crit Care Med 2007;8 (3) 236- 247
10. Agarwal N,Ram G et al“Critical Care without Walls”- Impact of a “Pediatric Emergency Team”on Picu Admissions from the Wards and Overall Mortality
11. Goldhill, D.R. et al. The patient-at-risk team: identifying and managing seriously ill ward patients.Anesthesia 1999;54:853- 860
12.Berwick DM, Calkins DR, McCannon CJ, Hackbarth AD. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA 2006; 295: 324-327.
13. Institute of Health Care Improvement (IHI) 2006. How to guide pediatric supplement Rapid Response Team; http://www.ihi.org. Accessed on 10 February 2009
2. Buist MD, Jarmolowski E, Burton PR, et al. Recognising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care. Med J Aust 1999; 171: 22-25.
3. Franklin C, Mathew J. Developing strategies to prevent inhospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event. Crit Care Med 1994; 22:244-247.
4. Shein RMH, Hazday N, Pena M, et al. Clinical antecedents to in-hospital cardiopulmonary arrest.Chest 1990; 98: 1388-1392.
5.James Tibballs, MB, BS, MD, BMedSc, MEd, MBA, MH lth & Med Law, Grad Dip Arts, FANZCA, FJFICM, FACLM; Sharon Kinney, RN, MN, PhD Reduction of hospital mortality and of preventable cardiac arrest and death on introduction of a pediatric medical emergency team. Pediatr Crit Care Med 2009; 10:306 –312).
6. Lee A, Bishop G, Hillman KM, Daffurn K: The Medical Emergency Team. Anaesth Intensive Care 1995, 23:183-186
7. D. R. Goldhill et al. Identifying and managing seriously ill ward patients. Anaesthesia, 1999, 54, pages 853±860
8. Tibballs J, Kinney S, Duke T, et al: Reduction of paediatric in-patient cardiac arrest and death with a medical emergency team: Preliminary results. Arch Dis Child 2005; 90: 1148–1152
9. Brilli RJ Gibson R Luria JW et al. Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit. Pediatr Crit Care Med 2007;8 (3) 236- 247
10. Agarwal N,Ram G et al“Critical Care without Walls”- Impact of a “Pediatric Emergency Team”on Picu Admissions from the Wards and Overall Mortality
11. Goldhill, D.R. et al. The patient-at-risk team: identifying and managing seriously ill ward patients.Anesthesia 1999;54:853- 860
12.Berwick DM, Calkins DR, McCannon CJ, Hackbarth AD. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA 2006; 295: 324-327.
13. Institute of Health Care Improvement (IHI) 2006. How to guide pediatric supplement Rapid Response Team; http://www.ihi.org. Accessed on 10 February 2009
Published
2016-07-28
Issue
Section
Original Article
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).