TABLE 2.
Event Risk Factors for Mortality During Clinical Deterioration Events
| Characteristic | All CDEs, n = 553 | CDE Survival, n = 394 | CDE Mortality, n = 159 | P value | Adjusted P value a |
|---|---|---|---|---|---|
| Patient characteristic | |||||
| Age: median [IQR], y | 8.1 [3.8‐13.1] | 8.5 [3.8‐13.3] | 7.3 [3.7‐12.4] | .2841 | .3934 |
| Male, n (%) | 306 (55.3%) | 219 (55.6%) | 87 (54.7%) | .8566 | .8566 |
| Oncologic diagnosis n (%) | .8020 | .8566 | |||
| Hematologic malignancy | 425 (76.8%) | 305 (77.4%) | 120 (75.5%) | ||
| Solid tumor | 120 (21.7%) | 84 (21.3%) | 36 (22.6%) | ||
| Other | 8 (1.5%) | 5 (1.3%) | 3 (1.9%) | ||
| Characteristic at start of CDE | |||||
| Event time of day b n (%) | .5057 | .6247 | |||
| Daytime: 7 am to 7 pm | 339 (61.3%) | 238 (60.4%) | 101 (63.5%) | ||
| Nighttime: 7 pm to 7 am | 214 (38.7%) | 156 (39.6%) | 58 (36.5%) | ||
| Day of the week n (%) | .8226 | .8566 | |||
| Weekday | 424 (76.7%) | 303 (76.9%) | 121 (76.1%) | ||
| Weekend | 129 (23.3%) | 91 (23.1%) | 38 (23.9%) | ||
| Any ICU‐level interventions on the floor n (%) | 162 (29.3%) | 99 (25.1%) | 63 (39.6%) | .0012 | .0028 |
| PEWS implemented at time of event? n (%) | 277 (50.1%) | 232 (58.9%) | 45 (28.3%) | <.0001 | <.0001 |
| ICU consult? n (%) | 478 (86.4%) | 353 (89.6%) | 125 (78.6%) | .0032 | .0066 |
| Transfer to higher level of care? n (%) | 498 (90.1%) | 363 (92.1%) | 135 (84.9%) | .0209 | .0313 |
| Reason for deterioration n (%) | |||||
| Sepsis/septic shock | 352 (63.7%) | 250 (63.5%) | 102 (64.2%) | .8137 | .8566 |
| Respiratory distress | 224 (40.5%) | 127 (32.2%) | 97 (61.0%) | <.0001 | <.0001 |
| Other CV dysfunction | 121 (21.9%) | 66 (16.8%) | 55 (34.6%) | <.0001 | <.0001 |
| Neurologic deterioration | 97 (17.5%) | 56 (14.2%) | 41 (25.8%) | .0036 | .0066 |
| High lactate: >2 mmol/L n (%) | 146 (26.4%) | 93 (23.6%) | 53 (33.3%) | .0008 | .0021 |
| Missing | 199 | 135 | 64 | ||
| Thrombocytopenia, <50/μL: n (%) | 248 (44.9%) | 162 (41.1%) | 86 (54.1%) | .0038 | .0066 |
| Missing | 26 | 19 | 7 | ||
| Neutropenia, ANC <500 n (%) | 280 (50.6%) | 196 (49.8%) | 84 (52.8%) | .3378 | .4434 |
| Missing | 31 | 20 | 11 | ||
| Any organ dysfunction | 390 (70.5%) | 245 (62.2%) | 145 (91.2%) | <.0001 | <.0001 |
| No. of organs with dysfunction: median [IQR] | 1 [0‐2] | 1 [0‐2] | 2 [1‐3] | <.0001 | <.0001 |
| Interventions required during CDE | |||||
| Vasoactive infusions n (%) | 319 (57.7%) | 177 (44.9%) | 142 (89.3%) | .0098 | .0158 |
| Any invasive mechanical ventilation c n (%) | 237 (42.9%) | 92 (23.4%) | 145 (91.3%) | <.0001 | <.0001 |
| Cardiopulmonary resuscitation n (%) | 77 (13.9%) | 2 (0.5%) | 75 (47.2%) | <.0001 | <.0001 |
| At the Time of Transfer to a Higher Level of Care | P value | Adjusted P value a | |||
|---|---|---|---|---|---|
| All Transfers, n = 498 | CDE Survival, n = 363 | CDE Mortality, n = 135 | |||
| PIM2 at time of transfer: median [IQR] | 6.3 [4.4‐11.4] | 5.75 [4.1‐8.5] | 11.66 [6‐33.2] | <.0001 | <.0001 |
| Sepsis at time of transfer n (%) | <.0001 | <.0001 | |||
| No | 154 (30.9%) | 120 (33.1%) | 34 (25.2%) | ||
| Sepsis | 118 (23.7%) | 100 (27.6%) | 18 (13.3%) | ||
| Severe sepsis | 47 (9.4%) | 34 (9.4%) | 13 (9.6%) | ||
| Septic shock | 179 (35.9%) | 109 (30.0%) | 70 (51.9%) | ||
| Any organ dysfunction at time of transfer n (%) | 367 (73.7%) | 232 (63.9%) | 135 (100.0%) | <.0001 | <.0001 |
| No. of organs with dysfunction: median [IQR] | 1 [0‐3] | 1 [0‐2] | 3 [2‐4] | <.0001 | <.0001 |
Abbreviations: ANC, absolute neutrophil count; CDE, clinical deterioration event; CV, cardiovascular; ICU, intensive care unit; IQR, interquartile range; PEWS, Pediatric Early Warning System; PIM, Pediatric Index of Mortality.
a
P values were adjusted for the false‐discovery rate.
b
For day (8 am to 4 pm) versus night (4 pm to 8 am), P = .788 (not significant).
c
Intubation or tracheostomy with mechanical ventilation was categorized as invasive.