• Kristina Krmpotic, Anna-Theresa Lobos, Jason Chan, Christina Toppozini, Candice McGahern, Franco Momoli, and Amy C Plint.
• Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
• Pediatr Crit Care Me. 2019 Jul 1; 20 (7): e293-e300.

ObjectivesTo identify the clinical findings available at the time of hospitalization from the emergency department that are associated with deterioration within 24 hours.DesignA retrospective case-control study.SettingA pediatric hospital in Ottawa, ON, Canada.PatientsChildren less than 18 years old who were hospitalized via the emergency department between January 1, 2008, and December 31, 2012. Cases (n = 98) had an unplanned admission to the PICU or unexpected death on the hospital ward within 24 hours of hospitalization and controls (n = 196) did not.InterventionsNone.Main ResultsNinety-eight children (53% boys; mean age 63.2 mo) required early unplanned admission to the PICU. Multivariable conditional logistic regression resulted in a model with five predictors reaching statistical significance: higher triage acuity score (odds ratio, 4.1; 95% CI, 1.7-10.2), tachypnea in the emergency department (odds ratio, 4.6; 95% CI, 1.8-11.8), tachycardia in the emergency department (odds ratio, 2.6; 95% CI, 1.1-6.5), PICU consultation in the emergency department (odds ratio, 8.0; 95% CI, 1.1-57.7), and admission to a ward not typical for age and/or diagnosis (odds ratio, 4.5; 95% CI, 1.7-11.6).ConclusionsWe have identified risk factors that should be included as potential predictor variables in future large, prospective studies to derive and validate a weighted scoring system to identify hospitalized children at high risk of early clinical deterioration.

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