Mortality Drops Despite Lack of Emergency Medical Team

Researchers question the limitations of before-and-after studies

TUESDAY, May 3 (HealthDay News) -- Despite the absence of a pediatric medical emergency team (PMET), researchers at a Canadian hospital found a decrease in hospital mortality over time, a finding they attribute less to their lack of a PMET than to the limitations of before-and-after study designs; their research has been published in the May issue of the Archives of Pediatrics & Adolescent Medicine.

Ari R. Joffe, M.D., of the University of Alberta and Stollery Children's Hospital in Edmonton, Canada, and colleagues examined data from their hospital, which did not have a PMET, to see whether mortality had decreased over time and to test their hypothesis that favorable results of PMET studies could be due to limitations in study design.

The researchers found a decrease in hospital mortality during the periods of two PMET studies that showed a drop in hospital mortality: 1.50 percent for 1999 to 2002 versus 0.82 percent for 2002 to 2006 and 1.02 percent for 2000 to 2005 versus 0.70 percent for 2005 to 2007. In the periods of three PMET studies that showed no change in or did not examine hospital mortality, the researchers did not find a significant change in mortality. They also found no changes in ward code or cardiopulmonary arrest rates over time. The authors concluded that their findings demonstrate the limitation of before-and-after study designs, and hypothesized that multiple cointerventions account for the drop in mortality.

"A large cluster-randomized controlled trial of PMET implementation with validated calling criteria is required to determine whether PMETs are effective," the authors write.

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