Characterization of Urgent ICU Consultations in the Evaluation of Processes of Care and the Outcomes of Children in Hospital (EPOCH) Randomized Clinical Trial

OBJECTIVES: Urgent ICU consultation is intended to elicit advice and consider ICU transfer. Our objective was to describe the nature and outcomes of ICU consultations across a global cohort. DESIGN: This is a secondary analysis of patients with one or more ICU consultations. A care episode was defined as consecutive urgent ICU consultations until an ICU admission or at least 2 weeks without an urgent ICU consultation. We describe consultation outcomes for the last care episode. Late escalations were defined by a Children's Resuscitation Intensity Scale score greater than 2. SETTING: Twenty-one centers participating in the Evaluation of Processes of Care and the Outcomes of Children in Hospital (EPOCH) cluster-randomized trial. PATIENTS: There were 4288 urgent ICU consultations in 3625 care episodes for 3000 patients with a median (interquartile range) age of 25 months (5-99 mo). INTERVENTIONS: In the parent EPOCH trial, hospitals were randomized to Bedside Pediatric Early Warning System or usual care; no intervention was assigned in this secondary analysis. MEASUREMENTS AND MAIN RESULTS: The outcomes of the 3000 last care episodes were in-consultation death in three (0.1%) and urgent ICU admission in 1477 (49.2%). Among 3000 first, 400 second, and 68 third consultations, the proportions of ICU admission were 42%, 44%, and 47%. The proportions of ICU admissions that were late escalation were similar across groups: 18% for first and second urgent ICU consultations, and 25% for third urgent ICU consultations. among patients having a second urgent ICU consultation, patients who had received resuscitation interventions in their first urgent ICU consultation (and remained on the ward) had more frequent resuscitation events (23.2% vs. 3.4%, p < 0.01) and had a similar frequency of late escalation (31.8% vs. 15.6%, p = 0.07) and ICU admission (51.1% vs. 43.1%, p = 0.40) compared with patients without resuscitation in their first urgent ICU consultation. CONCLUSIONS: Urgent consultation to the ICU is common during pediatric hospitalization. Repeated ICU consultation was associated with a similar frequency of late escalation. Resuscitation measures were provided in one of 12 ICU consultations where patients were not admitted to ICU and were a risk factor for late escalation in subsequent consultations.