Report: Hospital with no PMET saw drop in mortality
Although it lacks a pediatric medical emergency team (PMET), the University of Alberta and Stollery Children's Hospital, in Edmonton, Alberta, documented a reduction in hospital mortality over 10 years, according to a report in the May issue of Archives of Pediatrics & Adolescent Medicine.
Ari R. Joffe, MD, from the University of Alberta and Stollery Children's Hospital, Edmonton, Canada, and colleagues, evaluated data from their hospital. For their research, they reviewed pediatric discharges and inpatient deaths, the number of code calls and the number of cardiopulmonary arrests that occurred on the pediatric wards and resulted in admission to the pediatric intensive care unit.
The researchers then compared these data (from 1999 through 2009) during the same time periods used in several published studies of PMET effectiveness.
"During the periods of the three PMET studies showing no change in or not examining hospital mortality, we found no significant change in hospital mortality," they wrote. "The annual odds ratio for survival was 1.13. There were no changes in ward code and cardiopulmonary arrest rates over time."
Other interventions that were not measured by the PMET studies may have confounded the results of those studies, and hospitals such as theirs may already have systems and procedures that replicate the role of a PMET.
Favorable results in PMET studies may be due to limitations of study design, including the use of historical controls, inadequate risk and temporal trend adjustment, stated Joffe and colleagues.
"We claim that this finding demonstrates the limitation of before-and-after study designs (cohort studies with historical controls) in determining the effect of PMET implementation," they concluded, adding that larger and better-designed studies evaluating PMET are needed.
Ari R. Joffe, MD, from the University of Alberta and Stollery Children's Hospital, Edmonton, Canada, and colleagues, evaluated data from their hospital. For their research, they reviewed pediatric discharges and inpatient deaths, the number of code calls and the number of cardiopulmonary arrests that occurred on the pediatric wards and resulted in admission to the pediatric intensive care unit.
The researchers then compared these data (from 1999 through 2009) during the same time periods used in several published studies of PMET effectiveness.
"During the periods of the three PMET studies showing no change in or not examining hospital mortality, we found no significant change in hospital mortality," they wrote. "The annual odds ratio for survival was 1.13. There were no changes in ward code and cardiopulmonary arrest rates over time."
Other interventions that were not measured by the PMET studies may have confounded the results of those studies, and hospitals such as theirs may already have systems and procedures that replicate the role of a PMET.
Favorable results in PMET studies may be due to limitations of study design, including the use of historical controls, inadequate risk and temporal trend adjustment, stated Joffe and colleagues.
"We claim that this finding demonstrates the limitation of before-and-after study designs (cohort studies with historical controls) in determining the effect of PMET implementation," they concluded, adding that larger and better-designed studies evaluating PMET are needed.