Do paediatric early warning systems reduce mortality and critical deterioration events among children? A systematic review and meta-analysis

Chong, Shu-Ling; Goh, Mark Sen Liang; Ong, Gene Yong-Kwang; Acworth, Jason; Sultana, Rehena; Yao, Sarah Hui Wen; Ng, Kee Chong; Scholefield, Barnaby R.; Aickin, Richard; Maconochie, Ian; Atkins, Dianne L.; Couto, Thomaz Bittencourt; Guerguerian, Anne‐Marie; Kleinman, Monica E.; Kloeck, David; Nuthall, Gabrielle; Reis, Amélia G.; Rodrı́guez-Núñez, Antonio; Schexnayder, Steve; Tijssen, Janice A.; Voorde, Patrick Van de

doi:10.1016/j.resplu.2022.100262

Cited by 15 publications

(7 citation statements)

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“…On the other hand, our study did not show a significant difference in occurrence of critical events in the ARS activation group and the non-activation group. This was contrary to the results of a systematic review of RRS in children, which found that RRS introduction lowered incidence by predicting critical events [ 23 ]. Furthermore, the results differed from the results of Tibballs et al’s study [ 2 ], which is the basis of our ARS.…”

Section: Discussioncontrasting

confidence: 95%

Eleven years of experience in operating a pediatric rapid response system at a children’s hospital in South Korea

Jeon,

Lee,

Kim

et al. 2023

ACC

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Background: Various rapid response systems have been developed to detect clinical deterioration in patients. Few studies have evaluated single-parameter systems in children compared to scoring systems. Therefore, in this study we evaluated a single-parameter system called the acute response system (ARS).Methods: This retrospective study was performed at a tertiary children’s hospital. Patients under 18 years old admitted from January 2012 to August 2023 were enrolled. ARS parameters such as systolic blood pressure, heart rate, respiratory rate, oxygen saturation, and whether the ARS was activated were collected. We divided patients into two groups according to activation status and then compared the occurrence of critical events (cardiopulmonary resuscitation or unexpected intensive care unit admission). We evaluated the ability of ARS to predict critical events and calculated compliance. We also analyzed the correlation between each parameter that activates ARS and critical events.Results: The critical events prediction performance of ARS has a specificity of 98.5%, a sensitivity of 24.0%, a negative predictive value of 99.6%, and a positive predictive value of 8.1%. The compliance rate was 15.6%. Statistically significant increases in the risk of critical events were observed for all abnormal criteria except low heart rate. There was no significant difference in the incidence of critical events.Conclusions: ARS, a single parameter system, had good specificity and negative predictive value for predicting critical events; however, sensitivity and positive predictive value were not good, and medical staff compliance was poor.

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Section: Discussioncontrasting

confidence: 95%

Eleven years of experience in operating a pediatric rapid response system at a children’s hospital in South Korea

Jeon,

Lee,

Kim

et al. 2023

ACC

View full text Add to dashboard Cite

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“…[73] Paul J. Sharek and colleagues found that the intervention had a significant effect on non-ICU cardiorespiratory arrest; the estimated rate per 1000 admissions for the postintervention group was 0.29 times that of the preintervention group (95% CI, 0.10-0.65; P = 0.008). [74] Moreover, Chong SL and Goh MSL (2022) discovered identical results [75].Additionally, Saad Al-Qahtani, (2013) proclaimed that non-ICU cardiopulmonary arrests decreased from 1.4 to 0.9 per 1,000 hospital admissions (relative risk, 0.68; 95% confidence interval, 0.53-0.86; p = 0.001) [76] Joffe et al discovered no difference (2011) [77], and Tibballs J (2009) reported that unexpected cardiac arrests did not change from 0.19 per 1000 to 0.17 per 1000 (risk ratio 0.91, 95% CI (0.50-1.64, p value 0.75). [78] Finally we can conclude that a systemic review and meta-analysis on this regards, cardiorespiratory arrest outside of ICU, RR 0.62 CI (0.46-0.84), I210.2, p=0.35).…”

Section: Resultsmentioning

confidence: 82%

Improving Pediatric Patient Outcomes: An Interrupted Time Series (ITS) Approach to Explore the Impact of Rapid Response Teams in Reducing Unplanned PICU Admissions and Cardiopulmonary Arrests.

Al Harbi

2023

Preprint

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Background: Pediatric Rapid Response Teams (RRTs) are expected to significantly lower pediatric mortality in healthcare settings. This study evaluates RRTs' effectiveness in decreasing cardiac arrests and unexpected Pediatric Intensive Care Unit (PICU) admissions. Methods: A quasi-experimental study (2014-2017) at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, involved 3,261 pediatric inpatients, split into pre-intervention (1,604) and post-intervention (1,657) groups. The intervention entailed pediatric specialists collaboratively managing acute decompensations following set protocols. Results: RRT was activated 471 times, primarily for respiratory distress (29.30%), sepsis (22.30%), clinical anxiety (13.80%), and hematological abnormalities (6.7%). Family concerns triggered 0.1% of activations. Post-RRT implementation, unplanned PICU admissions significantly reduced (RR = 0.552, 95% CI 0.485-0.628, P < 0.0001), and non-ICU cardiac arrests were eliminated (RR = 0). Patient care improvement was notable, with a -9.61 coefficient for PICU admissions (95% CI: -12.65 to -6.57, P < 0.001) and a -1.641 coefficient for non-ICU cardiac arrests (95% CI: -2.22 to -1.06, P < 0.001). Sensitivity analysis showed mixed results for PICU admissions, while zero-inflation Poisson analysis confirmed a reduction in non-ICU arrests. Conclusions: The deployment of pediatric RRTs is associated with fewer unexpected PICU admissions and non-ICU cardiopulmonary arrests, indicating improved PICU management. Further research using robust scientific methods is necessary to conclusively determine RRTs' clinical benefits.

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“…[73] Paul J. Sharek and colleagues found that the intervention had a signi cant effect on non-ICU cardiorespiratory arrest; the estimated rate per 1000 admissions for the postintervention group was 0.29 times that of the preintervention group (95% CI, 0.10-0.65; P = 0.008). [74] Chong SL and Goh MSL (2022) discovered identical results [75]. Moreover, Saad Al-Qahtani, (2013) proclaimed that non-ICU cardiopulmonary arrests decreased from 1.4 to 0.9 per 1,000 hospital admissions (relative risk, 0.68; 95% con dence interval, 0.53-0.86; p = 0.001) [76] Joffe et al discovered no difference (2011) [77], and Tibballs J (2009) reported that unexpected cardiac arrests did not change from 0.19 per 1000 to 0.17 per 1000 (risk ratio 0.91, 95% CI (0.50-1.64, p value 0.75).…”

Section: Discussionmentioning

confidence: 79%

Causal impact of the Pediatric Rapid Response Team's actions on the reduction of unplanned PICU admissions and non-ICU cardiorespiratory arrest: Using the Google Causal Impact R Package.

Al-Harbi

2023

Preprint

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Background: The Pediatric Rapid Response Team has greatly cut down on unplanned admissions to the PICU, deaths of inpatients, and cardiopulmonary arrests outside of the PICU.There is no published study that shows a link between pediatric rapid response teams and a drop in cardiorespiratory arrests and unplanned PICU admissions due to acute decompensation in children. Method: Quasi-experimental before-and-after intervention, a cohort study. Single-center, tertiary-level academic hospital, King Abdulaziz University Hospital, Jeddah, Saudi Arabia. From January 2014 to July 2017, a total of 3261 pediatric ward patients were enrolled in this study for the pre-intervention period of 1604 and the post-intervention period of 1657. A pediatric rapid response team consists of a pediatric nurse, a respiratory therapist, a nursing supervisor, and a pediatric intensive care unit (ICU)-trained fellow or attending physician. This team evaluated, treated, and prioritized patients with decompensated conditions based on predetermined standards. Results: A total of 3281 pediatric ward patients were included in the study. 1604 individuals’ pre-intervention and 1677 individuals’ post-intervention participated. Preintervention lasted from January 1, 2014, to August 30, 2015, and postintervention lasted from September 1, 2015, to July 30, 2017. 471 pediatric rapid response teams have been activated in total. Respiratory distress (138/471, 29.30%), sepsis (105/471, 22.30%), physician concern (65/471, 13.80%), and hematology (32/471, 6.8%) were the most common causes for activation. Furthermore, family concern (3/471, 0.1%) was the least prevalent reason for activation. The relative risk of unplanned PICU admission after intervention was 0.55 (0.48–0.63), p value 0.0001, and cardiorespiratory arrest was 0.02 (0.001-0.32), p value 0.006. On unplanned PICU admission, the estimated causal inference from the fitted Bayesian structural time series model is an absolute effect of -11 (-13, -8.5), a relative effect of -45% (-55%, -36%), and a p value of 0.001. The absolute impact on cardiorespiratory arrest was -1.8 (-2.6, -0.99) and the relative effect was -100% (-145%, -55%) with a p-value of 0.001. Conclusions: Our experience with pediatric rapid response teams has shown that they are an excellent interventional instrument, and it's a brilliant patient safety initiative that transfers PICU reflexes outside the critical care unit to avoid non-PICU cardiopulmonary arrest and reduces unplanned critical care admissions.

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Do paediatric early warning systems reduce mortality and critical deterioration events among children? A systematic review and meta-analysis

Cited by 15 publications

References 45 publications

Eleven years of experience in operating a pediatric rapid response system at a children’s hospital in South Korea

Eleven years of experience in operating a pediatric rapid response system at a children’s hospital in South Korea

Improving Pediatric Patient Outcomes: An Interrupted Time Series (ITS) Approach to Explore the Impact of Rapid Response Teams in Reducing Unplanned PICU Admissions and Cardiopulmonary Arrests.

Causal impact of the Pediatric Rapid Response Team's actions on the reduction of unplanned PICU admissions and non-ICU cardiorespiratory arrest: Using the Google Causal Impact R Package.

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