Critical deterioration in children admitted to hospital, requiring emergency transfer to the Paediatric Intensive Care Unit

Abstract. Introduction. Critical deterioration in children admitted to hospital, which results in emergency transfer to the Paediatric Intensive Care Unit (PICU), is associated with increased morbidity and mortality. To date, the interventions aimed at reducing critical deterioration have focused on Paediatric Early Warning Scores (PEWS) and/or Rapid Response Team (RRT) utilisation. This thesis explored the association between antecedent risk factors and Critical Deterioration Events (CDE), and the clinical impact of PEWS utilisation on CDE and outcome. Finally, the proof-of-concept testing for an Electronic Physiological Surveillance System (EPSS) is presented, as an aid to deterioration recognition in children admitted to hospital. Methods. A fourteen-year dataset of PICU admissions, collected prospectively, was used to conduct a post-hoc epidemiological study. Antecedent risk factors associated with CDE were identified by comparing characteristics of the CDE cohort with other PICU admissions. The impact of PEWS, in different formats, on CDE were evaluated by comparing time segments of traditional clinical care (baseline) with the use of a paper-based PEWS trigger tool, a paper-based age-specific aggregate PEWS score and an age-specific aggregate PEWS score within the Electronic Patient Record (EPR). Comparisons were made between these time segments by standardising the data per 1,000 events. Finally, proof-of-concept-testing of an EPSS prototype for use in children was evaluated by comparing the time efficiency and accuracy of vital signs documentation, accuracy of PEWS calculation and user-perceptions of the clinical utility of this technology, compared with paper-based age-specific PEWS charts. Results. Antecedent risk factors associated with CDE were younger age (median 6 vs 10.5 months, p