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Pediatric METs and RRTs

Question Type:
Intervention
Full Question:
For infants and children in the in-hospital setting (P), does does the use of pediatric METs/RRTs (I), compared with compared with not using METs/RRTs (C), change Cardiac arrest frequency outside of the ICU, Cardiac arrest frequency, overall hospital mortality (O)?
Consensus on Science:
For the critical outcome of cardiac arrest outside the ICU, we identified very-low-quality evidence from 7 pediatric observational studies (downgraded for risk of bias, inconsistency, and imprecision). All 7 studies showed that the rate of cardiac arrest outside the ICU declined after institution of a MET/RRT system (unadjusted relative risk [RR] less than 1), but none achieved statistical significance.(Brilli 2007, 236-246; Hunt 2008, 117-122; Hanson 2009, 500-504; Tibballs 2009, 306-312; Anwar ul 2010, 273-276; Kotsakis 2011, 72-78; Bonafide 2014, 25-33) There was enough potential variability between the studies (of both patient and healthcare system factors, including the baseline incidence of cardiac arrest) that a decision was made to not pool the data. For the critical outcome of all arrests (cardiac and respiratory) outside the ICU, we identified very-low-quality evidence from 4 pediatric observational studies (downgraded for risk of bias and imprecision). One study(Sharek 2007, 2267-2274) demonstrated a statistically significant decline (P=0.0008), whereas the other 3 studies(Zenker 2007, 418-425; Hunt 2008, 117-122; Hayes 2012, e785-e791) did not. For the critical outcome of respiratory arrest, we identified very-low-quality evidence from 1 pediatric observational study(Hunt 2008, 117-122) (downgraded for risk of bias and imprecision) that observed a decline in respiratory arrests (RR, 0.27; 95% confidence interval [CI], 0.05–1.01; P=0.035). For the important outcome of cardiac arrest frequency, we identified very-low-quality evidence from 1 pediatric observational study(Brilli 2007, 236-246) (downgraded for risk of bias and imprecision) that was not statistically significant (RR, 0.3; 95% CI, 0–1.04; P=0.07). For the important outcome of overall hospital mortality, we identified very-low-quality evidence from 6 pediatric observational studies (downgraded for risk of bias, inconsistency, and imprecision). Three studies(Brilli 2007, 236-246; Sharek 2007, 2267-2274; Tibballs 2009, 306-312) observed a decline in deaths, and 3 did not.(Zenker 2007, 418-425; Hanson 2010, 314-318; Kotsakis 2011, 72-78)
Treatment Recommendation:
We suggest the use of pediatric MET/RRT systems in hospitals that care for children (weak recommendation, very-low-quality evidence). Values, Preferences, and Task Force Insights In making this recommendation, we place a higher value on the potential to recognize and intervene for patients with deteriorating illness over the expense incurred by a healthcare system by committing significant resources to implement a MET/RRT system. We recognize that the decision to use a MET/RRT system should be balanced by the existing resources and capabilities of the institution.
CoSTR Attachments:
CoSTaR MET (Final).docx    

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