M. L. Brown1, R. Moreci1, E. Long1, H. Robinson1, M. Maurer1, B. Bienvenu1, D. Danos1, J. Wood2 1Louisiana State University Health Sciences Center, Surgery, New Orleans, LA, USA 2Our Lady of the Lake, Pediatric Surgery, Baton Rouge, LA, USA
Introduction:
Hospitalized patients are subjected to overnight vital sign (OVS) monitoring with subsequent sleep disturbance, adverse outcomes, negative hospital experiences, and inefficient staff utilization. Previous studies in non-surgical pediatric populations have shown that routine OVS checks infrequently detect clinically significant events. We hypothesized that routine OVS assessment in pediatric surgery patients admitted to the floor rarely detect abnormalities or result in meaningful clinical interventions.
Methods:
We performed a retrospective chart review of all patients > 5 years of age admitted to the pediatric surgery service at a freestanding Children’s Hospital from 2019-2021. Trauma patients and patients admitted to the intensive care unit were excluded from analysis. Overnight vital signs were defined as those recorded between 10pm and 6am. Data were analyzed using t-tests and Fisher’s Exact tests.
Results:
Analysis included 187 patients aged 5-19 years (median age 15), of whom 60.4% were male and 49% were white. At least one OVS was flagged as abnormal in 59% of patients, with no demographic differences compared to those without flagged OVS. Abnormal blood pressure was the most commonly flagged OVS (80%), followed by temperature (52%), heart rate (22%), respiratory rate (14%), and O2 saturation (3%). The rate of intervention for flagged OVS was 65%, with administration of medication being most common (62%), followed by ordering of cultures (4.5%) or imaging (3.6%). Medications for fever were the most common medication administration (42 patients) followed by pain medication (39 patients). Unplanned operative intervention and transfer to the ICU were uncommon (0.9% and 1.9%, respectively). Compared to patients with other diagnoses, patients with appendicitis were more likely to have flagged OVS (72% vs 50.9%, p=0.004) and subsequent intervention (50.6% vs 30.6%, p=0.006).
Conclusion:
While the majority of pediatric surgery floor patients had at least one flagged overnight vital sign, serious complications requiring operative intervention or escalation of care were rarely detected by routine assessments. Identifying and targeting specific patient populations who will benefit from routine overnight assessments may simultaneously help with staffing efficiency and improve patient outcomes and satisfaction for pediatric surgical patients.