PT  - JOURNAL ARTICLE
AU  - Rob Trubey
AU  - Chao Huang
AU  - Fiona V Lugg-Widger
AU  - Kerenza Hood
AU  - Davina Allen
AU  - Dawn Edwards
AU  - David Lacy
AU  - Amy Lloyd
AU  - Mala Mann
AU  - Brendan Mason
AU  - Alison Oliver
AU  - Damian Roland
AU  - Gerri Sefton
AU  - Richard Skone
AU  - Emma Thomas-Jones
AU  - Lyvonne N Tume
AU  - Colin Powell
TI  - Validity and effectiveness of paediatric early warning systems and track and trigger tools for identifying and reducing clinical deterioration in hospitalised children: a systematic review
AID  - 10.1136/bmjopen-2018-022105
DP  - 2019 May 01
TA  - BMJ Open
PG  - e022105
VI  - 9
IP  - 5
4099  - http://bmjopen.bmj.com/content/9/5/e022105.short
4100  - http://bmjopen.bmj.com/content/9/5/e022105.full
SO  - BMJ Open2019 May 01; 9
AB  - Objective To assess (1) how well validated existing paediatric track and trigger tools (PTTT) are for predicting adverse outcomes in hospitalised children, and (2) how effective broader paediatric early warning systems are at reducing adverse outcomes in hospitalised children.Design Systematic review.Data sources British Nursing Index, Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effectiveness, EMBASE, Health Management Information Centre, Medline, Medline in Process, Scopus and Web of Knowledge searched through May 2018.Eligibility criteria We included (1) papers reporting on the development or validation of a PTTT or (2) the implementation of a broader early warning system in paediatric units (age 0–18 years), where adverse outcome metrics were reported. Several study designs were considered.Data extraction and synthesis Data extraction was conducted by two independent reviewers using template forms. Studies were quality assessed using a modified Downs and Black rating scale.Results 36 validation studies and 30 effectiveness studies were included, with 27 unique PTTT identified. Validation studies were largely retrospective case-control studies or chart reviews, while effectiveness studies were predominantly uncontrolled before-after studies. Metrics of adverse outcomes varied considerably. Some PTTT demonstrated good diagnostic accuracy in retrospective case-control studies (primarily for predicting paediatric intensive care unit transfers), but positive predictive value was consistently low, suggesting potential for alarm fatigue. A small number of effectiveness studies reported significant decreases in mortality, arrests or code calls, but were limited by methodological concerns. Overall, there was limited evidence of paediatric early warning system interventions leading to reductions in deterioration.Conclusion There are several fundamental methodological limitations in the PTTT literature, and the predominance of single-site studies carried out in specialist centres greatly limits generalisability. With limited evidence of effectiveness, calls to make PTTT mandatory across all paediatric units are not supported by the evidence base.PROSPERO registration number CRD42015015326