Should you send a tachycardic child home home from the ED?

I’d encourage you all to check out the following article just posted to Annals of Emergency Medicine.


Is Tachycardia at Discharge From the Pediatric Emergency Department a Cause for Concern? A Nonconcurrent Cohort Study 

Wilson, Florin, Huang, Fenchel and Mittiga

Annals of Emergency Medicine, February 2017


This is a review of over 120,000 patients from two pediatric EDs and 4 urgent cares and looked specifically at children discharged home with tachycardia. In the study at least 8% were tachycardic when they left the ED as defined by age-related heart rate normal limits. In the authors’ univariate model they noted the following:

When I asked lead author Paria Wilson what she wanted folks to take away from the article this is what she said:

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I felt like we were always taught that tachycardia in patients was a bad thing. We all know about shock and cardiac dysfunction presenting with tachycardia but children in the ER are always pissed off or febrile, which makes them tachycardic, so is it always a bad thing? We sought to answer this question by doing a large non-concurrent single center cohort study of pediatric patients (<19y) discharged from the emergency department and urgent cares. We were interested in the association of tachycardia at discharge (at the 99th percentile for age) with revisit within 72 hours and clinical outcomes on revisit. We found that 8.3% of children had tachycardia at discharge, and this did increase their risk of revisit and receipt of medications such as oxygen, breathing treatments and IV fluids and admission, but on that revisit, no one was receiving life saving procedures. So maybe its not as bad as we thought it was, maybe its just kids being kids, and progression of their disease processes.

Paria Wilson, MD, MEd, Cincinnati Children’s Hospital Medical Center

You can follow Dr. Wilson on Twitter @PWils814

References

Wilson, Florin, Huang, Fenchel and Mittiga. Is Tachycardia at Discharge From the Pediatric Emergency Department a Cause for Concern? A Nonconcurrent Cohort Study. Annals of Emergency Medicine, February 2017.

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