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Pediatric Patients Discharged from the Emergency Department with Abnormal Vital Signs

  • Author(s): Winter, Josephine
  • Waxman, Michael J.
  • Waterman, George
  • Ata, Ashar
  • Frisch, Adam
  • Collins, Kevin P.
  • King, Christopher
  • et al.
Abstract

Introduction: Children often present to the emergency department (ED) with minor conditionssuch as fever and have persistently abnormal vital signs. W e hypothesized that a significantportion of children discharged from the ED would have abnormal vital signs and that thosedischarged with abnormal vital signs would experience very few adverse events.

Methods: We performed a retrospective chart review encompassing a 44-month period of allpediatric patients (aged two months to 17 years) who were discharged from the ED with anabnormal pulse rate, respiratory rate, temperature, or oxygen saturation. We used a local qualityassurance database to identify pre-defined adverse events after discharge in this population.Our primary aim was to determine the proportion of children discharged with abnormal vitalsigns and the frequency and nature of adverse events. Additionally, we performed a subanalysiscomparing the rate of adverse events in children discharged with normal vs. abnormalvital signs, as well as a standardized review of the nature of each adverse event.

Results: Of 33,185 children discharged during the study period, 5,540 (17%) of thesepatients had at least one abnormal vital sign. There were 24/5,540 (0.43%) adverse eventsin the children with at least one abnormal vital sign vs. 47/27,645 (0.17%) adverse events inthe children with normal vital signs [relative risk = 2.5 (95% confidence interval, 1.6 to 2.4)].However, upon review of each adverse event we found only one case that was related tothe index visit, was potentially preventable by a 23-hour hospital observation, and causedpermanent disability.

Conclusion: In our study population, 17% of the children were discharged with at least oneabnormal vital sign, and there were very few adverse (0.43%) events associated with this practice.Heart rate was the most common abnormal vital sign leading to an adverse event. Severe adverseevents that were potentially related to the abnormal vital sign(s) were exceedingly rare. Additionalresearch is needed in broader populations to better determine the rate of adverse events andpossible methods of avoiding them. [West J Emerg Med. 2017;18(5)878-883.]

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