How Ominous is Tachycardia at ED Discharge?

Published September 2017 | Annals of Emergency Medicine

A study of more than 126,000 children discharged from Cincinnati Children’s emergency departments (ED) and urgent care centers raises questions about the clinical significance of elevated heart rates for age and its impact on revisits, a common measure of quality care.

The study, led by first author Paria Wilson, MD, MEd, found that return visits were 30 percent more likely among the 10,470 children in the study who were discharged with tachycardia, defined as a heart rate at the 99th percentile for age. Having tachycardia was associated with receipt of some “clinically important” interventions, such as respiratory support or antibiotics upon revisit, but was not associated with any life-saving procedures.

“It wasn’t profoundly surprising to find out we’re not doing resuscitations or life-saving procedures on children who are sent home and who revisit, because these are just rare occurrences in children in general,” Wilson says. “It is likely that screening for tachycardia at discharge is not the ideal method for identifying impending physiologic deterioration, and focused efforts at addressing all tachycardia before discharge may be unwarranted."

Nationally, revisits represent 2.5 to 3.5 percent of all ED visits. At Cincinnati Children’s, about seven to 10 ED patients a day are revisits, which impacts daily volumes and flow. “Understanding factors that may impact ED flow, such as vital sign reassessments, is really important for delivering timely care,” Wilson says.

The Division of Biostatistics and Epidemiology also contributed to this study.