• Brianna McKelvie, James Dayre McNally, Jason Chan, Franco Momoli, Christa Ramsay, and Anna-Theresa Lobos.
• 1Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. 2Division of Critical Care, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. 3Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
• Pediatr Crit Care Me. 2017 Jun 1; 18 (6): 571-579.

ObjectiveRapid response systems using medical emergency teams reduce hospital wide cardiorespiratory arrest and mortality. While rapid response systems improve hospital-wide outcomes, children receiving medical emergency team review may still be at increased risk for morbidity and mortality. The study purpose was to compare the length of stay and mortality rate in children receiving a medical emergency team review with those of other hospitalized children.DesignRetrospective cohort study.SettingTertiary Pediatric Hospital, Children's Hospital of Eastern Ontario, Ottawa, Canada.PatientsCohort of 42,308 pediatric admissions to the general inpatient ward.InterventionsData over 7 years were obtained from a prospectively maintained rapid response systems database.Measurements And Main ResultsFrom the cohort, 995 (2.35%) of the admissions had one and 276 (0.65%) had multiple medical emergency team activations. When compared with patients without, children having one or multiple medical emergency team reviews had 13.34 (95% CI, 5.33-33.2) and 50.10 (95% CI, 19.86-126.39) times the odds of death, respectively. Patients experiencing a medical emergency team review stayed in hospital 1.59 times (95% CI, 1.39-1.82) longer, whereas those with multiple medical emergency team reviews stayed 2.44 times (95% CI, 1.85-3.20) longer. The associations remained significant after controlling for important confounders and excluding elective admissions from the analyses. Most repeat medical emergency team reviews occurred within a day of the initial review or involved patients with multiple comorbidities.ConclusionsOur study suggests that pediatric patients reviewed by the medical emergency team are at significantly higher risk of mortality and longer length of stay than general ward inpatients. As well, patients with multiple medical emergency team reviews were at particularly high risk compared with patients with one medical emergency team review. Patients who experience medical emergency team reviews should be recognized as a high-risk group, and future studies should consider how to decrease morbidity and mortality. Based on our findings, we suggest that these patients be followed for 24-48 hours after any medical emergency team activation.

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