P2.009: Early Transfers in Pediatric Cardiac Patients: How Common, Who’s at Risk, and What Happens Next

Background: In the general pediatric population, early transfer from the general care unit to the intensive care unit (ICU) within 24 hours of admission has been associated with increased length of stay. Patients with cardiac disease are a unique group of patients in which the relevance of early transfers has not been well investigated. We aimed to determine the frequency of early transfer in the pediatric cardiology population at our institution, risk factors for early transfer, and outcomes based on timing of cardiac ICU (CICU) transfer.

Methods: In this single-center retrospective cohort study we included patients with unplanned admissions to the acute care cardiology unit (ACCU) at our tertiary care children’s hospital between February 2019 and October 2024. Patients transferred to the CICU were categorized by duration from admission to transfer (0-12h, 12-24h, 24-48h). Patient diagnoses were grouped into mild, moderate, or severe biventricular and univentricular diagnoses based on previous studies.

Results: There were 2,848 admissions during this period with 114 (4%) transfers within 24 hours and 147 (5.2%) transfers within 48 hours. There were no differences identified between patients based on language, race, or cardiac diagnoses. The majority of patients were transferred for cardiovascular or respiratory decline for the 0-12 hour group (42% and 42%), the 12-24 hour group (42 % and 37%) and the 24-48 hour group (42% and 39%). A higher proportion of patients transferred within 12 hours (18%) had undergone Stage 1 Palliation compared to patients transferred later (10% of 12-24h and 0% of 24-48h). Compared to patients that were not transferred, those that were transferred to the ICU were more likely to have had a previous ICU stay in the past year (48-63% vs 5.3%). There were no differences identified in ICU length of stay based on timing of transfer however patients transferred within 0-12 hours had shorter total post-transfer hospital length of stay (9 days, interquartile range (IQR) 5,20) compared to patients transferred 24-48 hours (16 days, IQR 11,29).

Conclusion: This study demonstrates that up to 4% of pediatric cardiology patients with admissions to the ACCU required transfer to the CICU within 24 hours and 5.2% within 48 hours. Aside from higher rates of early transfer compared to the general pediatric population, a greater proportion of patients were transferred for cardiovascular deterioration. Patients transferred to the CICU were more likely to have had a recent ICU admission. Patients transferred within 0-12 hours had shorter total post-transfer hospital length of stay compared to patients transferred 24-48 hours. There were no differences noted in overall in-hospital mortality or ECMO utilization. These data might help identify patients with a greater risk of transfer to the CICU early in their admission.