Summary of early warning system effectiveness study outcomes
Outcome | First author, year | Intervention | PTTT | Country | Number of centres | Specialist unit? | Existing RRT/ MET? | Population | Study design | Study duration in months | Events before, n (rate) | Events after, n (rate) | Effect size (95% CI) | P value | Quality score (max=26) | |||
Implemented a new PTTT | Implemented new RRT/ MET | Modified escalation process | Staff training/ education | |||||||||||||||
Mortality | ||||||||||||||||||
Deaths on ward (per 1000 admissions) | Tibballs 200513 | ✓ | ✓ | ✓ | Melbourne Activation Criteria | Australia | 1 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 53 (41 before, 12 after) | 13 (0.12) | 2 (0.06) | RR=0.45 (0.10 to 1.99)† | 0.29 | 10 | |
Hospital-wide deaths (per 100 discharges) | Sharek 200717 | ✓ | ✓ | ✓ | Paediatric rapid response team (RRT) triggering criteria | USA | 1 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 84 (67 before, 17 after) | 547 (1.01) | 158 (0.83) | RR=0.82 (0.70 to 0.95) | 0.007 | 15 | |
Hospital-wide deaths, excluding neonate ICU and ED (per 1000 discharges) | Zenker 200760 | ✓ | ✓ | RRT activation criteria* | USA | 1 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 34 (23 before, 11 after) | 97 (4.30) | 52 (4.45) | RR=1.04 (0.74 to 1.45)† | 0.57 | 12 | ||
Deaths outside ICU (per 1000 non-ICU patient-days) | Brilli 200715 | ✓ | ✓ | ✓ | Paediatric medical emergency team triggering criteria (a) | USA | 1 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 27 (15 before, 12 after) | 9 (0.10) | 2 (0.04) | RR=0.39 (0.08 to 1.80)† | 0.13 | 14 | |
Ward death rate (per 1000 ward admissions) | Hanson 201061 | ✓ | ✓ | ✓ | Not described | USA | 1 | Y | N | All inpatients | Uncontrolled before-after study (retrospective) | 36 (24 before, 12 after) | 13 (1.50) | 2 (0.45) | RR=0.30 (0.07 to 1.31)† | 0.07 | 18 | |
Total hospital deaths (per 1000 admissions) | Tibballs 200962 | ✓ | ✓ | ✓ | Melbourne Activation Criteria | Australia | 1 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 89 (41 before, 48 after) | 459 (4.38) | 398 (2.87) | RR=0.65 (0.57 to 0.75) | <0.0001 | 15 | |
Deaths on ward (per 1000 admissions) | Tibballs 200962 | ✓ | ✓ | ✓ | Melbourne Activation Criteria | Australia | 1 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 89 (41 before, 48 after) | 13 (0.12) | 6 (0.04) | RR=0.35 (0.13 to 0.92) | 0.03 | 15 | |
All-cause hospital mortality (per 1000 admissions) | Kotsakis 201163 | ✓ | ✓ | Modified Melbourne Activation Criteria | Canada | 4 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 48 (24 before, 24 after) | 553 (9.97) | 540 (9.65) | RR=0.97 (0.83 to 1.12) | 0.65 | 18 | ||
All-cause hospital mortality (per 1000 discharges) | Parshuram 201864 | ✓ | ✓ | ✓ | Bedside PEWS | Belgium, Ireland, The Netherlands, England, Italy, Canada, New Zealand | 21 | Y | N | All inpatients | Cluster randomised trial (prospective) | 18 (6 pre, 12 post) | Con: 61 (1.31) | Con: 147 (1.56) | OR=1.01 (0.61 to 1.69) | 0.96 | 23 | |
Int: 52 (1.95) | Int: 97 (1.93) | |||||||||||||||||
Hospital mortality (per 1000 admissions) | Kutty 201873 | ✓ | NR | USA | 38 | Y | N | All inpatients | Interrupted time series (retrospective) | 180 (60 before, 120 after) | N/A | N/A | OR=0.94 (0.93 to 0.95) | 0.98 | 20 | |||
PICU mortality | ||||||||||||||||||
PICU mortality after PICU admission from ward (per PICU admission) | Anwar-al-Haque, 201018 | ✓ | ✓ | Paediatric RRT triggering criteria (b) | Pakistan | 1 | Y | N | All inpatients | Uncontrolled before-after study (retrospective) | 18 (9 before, 9 after) | 23 (51.11) | 5 (15.63) | RR=0.31 (0.13 to 0.72)† | 0.007† | 6 | ||
PICU mortality after PICU readmission within 48 hours of discharge (per 1000 admissions) | Kotsakis 201163 | ✓ | ✓ | Modified Melbourne Activation Criteria | Canada | 4 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 48 (24 before, 24 after) | 16 (0.29) | 7 (0.13) | RR=0.43 (0.17 to 0.99) | <0.05 | 18 | ||
PICU mortality after urgent PICU admission from ward (per 1000 admissions) | Kotsakis 201163 | ✓ | ✓ | Modified Melbourne Activation Criteria | Canada | 4 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 48 (24 before, 24 after) | 70 (1.3) | 61 (1.1) | RR=0.90 (0.70 to 1.00) | 0.25 | 18 | ||
Death prior to discharge (per unplanned PICU transfer) | Bonafide 201465 | ✓ | ✓ | Bedside PEWS | USA | 1 | Y | N | All inpatients | Interrupted time series study (prospective) | 59 (32 before, 27 after) | 51 (6.3) | 56 (6.5) | RR=1.03 (0.72 to 1.49)† | 0.99 | 23 | ||
PICU mortality (per PICU admission) | Duns 201466 | ✓ | Between the Flags (BTS) tool* | Australia | 1 | Y | Y | All inpatients | Uncontrolled before-after study (prospective) | 48 (24 before, 24 after) | 30 (8.57) | 20 (5.49) | RR=0.64 (0.37 to 1.11)† | 0.14 | 7 | |||
Death in PICU (per 1000 patient-days) | Agulnik 201767 | ✓ | ✓ | Children’s Hospital Cardiac Early Warning Score (C-CHEWS) | Guatemala | 1 | Y | N | Oncology unit | Uncontrolled before-after study (retrospective) | 24 (12 before, 12 after) | 21 (1.25) | 22 (1.10) | RR=0.89 (0.49 to 1.61)† | 0.76 | 19 | ||
Death in PICU (per emergency PICU admission) | Sefton 201568 | ✓ | ✓ | ✓ | Modified Bristol PEWT (a) | UK | 1 | Y | N | All PICU admissions | Controlled before-after study (retrospective) | 24 (12 before, 12 after) | 17 (10.8) | 14 (8.4) | RR=0.78 (0.40 to 1.53)† | 0.47 | 16 | |
Deaths in PICU (per unplanned PICU admission) | Kolovos 201869 | ✓ | ✓ | RRT activation criteria* | USA | 1 | Y | N | All unplanned PICU admissions | Uncontrolled before-after study (retrospective) | 78 (42 before, 36 after) | 54† (4.9) | 40† (3.8) | RR=0.77 (0.52 to 1.15)† | 0.20† | 12 | ||
PICU mortality (per 1000 discharges) | Parshuram 201864 | ✓ | ✓ | ✓ | Bedside PEWS | Belgium, Ireland, The Netherlands, England, Italy, Canada, New Zealand | 21 | Y | N | All inpatients | Cluster randomised trial (prospective) | 18 (6 pre, 12 post) | Con: 34 (0.73) | Con: 91 (0.96) | OR=0.95 (0.48 to 1.86) | 0.88 | 23 | |
Int: 33 (1.24) | Int: 56 (1.12) | |||||||||||||||||
Cardiac arrest | ||||||||||||||||||
Cardiac arrests on ward (per 1000 admissions) | Tibballs 200513 | ✓ | ✓ | ✓ | Melbourne Activation Criteria | Australia | 1 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 53 (41 before, 12 after) | 20 (0.19) | 4 (0.11) | RR=0.58 (0.20 to 1.70) | 0.33 | 10 | |
Cardiopulmonary arrests (per 1000 non-ICU patient-days) | Brilli 200715 | ✓ | ✓ | ✓ | Paediatric medical emergency team triggering criteria (a) | USA | 1 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 27 (15 before, 12 after) | 7 (0.08) | 2 (0.04) | RR=0.50 (0.10 to 2.42)† | 0.11 | 14 | |
Ward cardiac arrest rate (per 1000 ward admissions) | Hanson 201061 | ✓ | ✓ | ✓ | Not described | USA | 1 | Y | N | All inpatients | Uncontrolled before-after study (retrospective) | 36 (24 before, 12 after) | 11 (1.27) | 2 (0.45) | RR=0.35 (0.08 to 1.58)† | 0.13 | 18 | |
Ward cardiopulmonary arrests (per 1000 patient-days) | Hunt 200816 | ✓ | ✓ | Paediatric medical emergency team triggering criteria | USA | 1 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 24 (12 before, 12 after) | 5 (0.10) | 5 (0.10) | RR=0.98 (0.22 to 4.24) | 0.97 | 17 | ||
Preventable cardiac arrests (per 1000 admissions) | Tibballs 200962 | ✓ | ✓ | ✓ | Melbourne Activation Criteria | Australia | 1 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 89 (41 before, 48 after) | 17 (0.16) | 10 (0.07) | RR=0.45 (0.20 to 0.97) | 0.04 | 15 | |
Unexpected cardiac arrests (per 1000 admissions) | Tibballs 200962 | ✓ | ✓ | ✓ | Melbourne Activation Criteria | Australia | 1 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 89 (41 before, 48 after) | 20 (0.19) | 24 (0.17) | RR=0.91 (0.50 to 1.64) | 0.75 | 15 | |
Actual cardiopulmonary arrests (per 1000 ward admissions) | Kotsakis 201163 | ✓ | ✓ | Modified Melbourne Activation Criteria | Canada | 4 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 48 (24 before, 24 after) | 69 (1.9) | 66 (1.8) | RR=0.95 (0.76 to 1.96) | 0.68 | 18 | ||
Near cardiopulmonary arrests (per 1000 admissions) | Kotsakis 201163 | ✓ | ✓ | Modified Melbourne Activation Criteria | Canada | 4 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 48 (24 before, 24 after) | 123 (3.4) | 67 (1.9) | RR=0.54 (0.52 to 0.57) | <0.001 | 18 | ||
Cardiac arrests on ward (per 1000 non-ICU patient-days) | Bonafide 201465 | ✓ | ✓ | Bedside PEWS | USA | 1 | Y | N | All inpatients | Interrupted time series study (prospective) | 59 (32 before, 27 after) | 6† (0.03) | 2† (0.01) | RR=0.36 (0.07 to 1.78)† | 0.21 | 23 | ||
Cardiac arrests (per 1000 patient-days) | Parshuram 201864 | ✓ | ✓ | ✓ | Bedside PEWS | Belgium, Ireland, The Netherlands, England, Italy, Canada, New Zealand | 21 | Y | N | All inpatients | Cluster randomised trial (prospective) | 18 (six pre, 12 post) | Con: 18 (0.11) | Con: 32 (0.10) | RR=1.02 (0.65 to 1.62) | 0.92 | 23 | |
Int: 15 (0.12) | Int: 27 (0.11) | |||||||||||||||||
Respiratory arrest | ||||||||||||||||||
Ward respiratory arrests (per 1000 patient-days) | Hunt 200816 | ✓ | ✓ | Paediatric medical emergency team triggering criteria | USA | 1 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 24 (12 before, 12 after) | 11 (0.23) | 3 (0.06) | RR=0.27 (0.07 to 0.95) | 0.04 | 17 | ||
Cardiac or respiratory arrest | ||||||||||||||||||
Cardiac or respiratory arrest (per 1000 discharges) | Zenker 200760 | ✓ | ✓ | RRT activation criteria* | USA | 1 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 34 (23 before, 11 after) | 180 (7.98) | 60 (5.13) | RR=0.64 (0.48 to 0.86)† | 0.19 | 12 | ||
Code calls (per 1000 non-ICU patient-days) | Brilli 200715 | ✓ | ✓ | ✓ | Paediatric medical emergency team triggering criteria (a) | USA | 1 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 27 (15 before, 12 after) | 25 (0.27) | 6 (0.11) | RR=0.42 (0.17 to 1.03)† | 0.06† | 14 | |
Code calls (per 1000 non-ICU patient-days) | Sharek 200717 | ✓ | ✓ | ✓ | Paediatric RRT triggering criteria | USA | 1 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 84 (67 before, 17 after) | 53 (0.52) | 5 (0.15) | RR=0.29 (0.10 to 0.65) | 0.008 | 15 | |
Code calls (per 1000 admissions) | Anwar-al-Haque 201018 | ✓ | ✓ | Paediatric RRT triggering criteria (b) | Pakistan | 1 | Y | N | All inpatients | Uncontrolled before-after study (retrospective) | 18 (9 before, 9 after) | 26 (5.25) | 12 (2.73) | RR=0.52 (0.26 to 1.03) | 0.06 | 6 | ||
Calls for urgent review/assistance | ||||||||||||||||||
Urgent calls to respiratory therapist (per 1000 patient-days) | Parshuram 201170 | ✓ | ✓ | ✓ | Bedside PEWS | Canada | 1 | N | N | All inpatients | Uncontrolled before-after study (prospective) | 8 (3 before, 5 after) | 8 (9.5) | 8 (3.4) | RR=0.36 (0.13 to 0.95)† | 0.04† | 23 | |
Urgent calls to paediatrician (per 1000 patient-days) | Parshuram 201170 | ✓ | ✓ | ✓ | Bedside PEWS | Canada | 1 | N | N | All inpatients | Uncontrolled before-after study (prospective) | 8 (3 before, 5 after) | 19 (22.6) | 12 (5.1) | RR=0.23 (0.11 to 0.46)† | <0.0001 | 23 | |
Code blue calls on the ward (per 1000 admissions) | Kotsakis 201163 | ✓ | ✓ | Modified Melbourne Activation Criteria | Canada | 4 | Y | N | All inpatients | Uncontrolled before-after study (prospective) | 48 (24 before, 24 after) | 210 (3.75) | 150 (2.70) | RR=0.71 (0.61 to 0.83) | <0.0001 | 18 | ||
Urgent calls to outreach team (per 1000 admissions) | Duns 201466 | ✓ | Between the Flags tool* | Australia | 1 | Y | Y | All inpatients | Uncontrolled before-after study (prospective) | 48 (24 before, 24 after) | 1058 (39.5) | 2120 (76.0) | RR=1.92 (1.79 to 2.07)† | 0.02 | 7 | |||
RRT calls (per 1000 patient-days) | Panesar 201471 | ✓ | Modified Brighton PEWS (e) | USA | 1 | Y | Y | All inpatients | Uncontrolled before-after study (retrospective) | 42 (18 before, 24 after) | 44 (3.14) | 69 (4.23) | RR=1.35 (0.92 to 1.96)† | 0.11 | 15 | |||
RRT calls (per 1000 patient days) | Douglas 201672 | ✓ | ✓ | ✓ | Modified Brighton PEWS (b) | USA | 1 | Y | Y | All inpatients | Uncontrolled before-after study (retrospective) | 24 (12 before, 12 after) | 194 (6.17) | 292 (9.80) | RR=1.59 (1.33 to 1.90)† | <0.001 | 12 | |
Code calls (per 1000 patient days) | Douglas 201672 | ✓ | ✓ | ✓ | Modified Brighton PEWS (b) | USA | 1 | Y | Y | All inpatients | Uncontrolled before-after study (retrospective) | 24 (12 before, 12 after) | 31 (0.98) | 20 (0.67) | RR=0.68 (0.39 to 1.19)† | 0.21 | 12 | |
PICU transfers | ||||||||||||||||||
Transfers from ward to other specialist units (per 1000 patient-days) | Parshuram 201170 | ✓ | ✓ | ✓ | Bedside PEWS | Canada | 1 | N | N | All inpatients | Uncontrolled before-after study (prospective) | 8 (3 before, 5 after) | 5 (5.9) | 19 (8.1) | RR=1.37 (0.51 to 3.63)† | 0.54† | 23 | |
Clinical deterioration events on ward prior to transfer to specialist unit (per 1000 patient-days) | Parshuram 201170 | ✓ | ✓ | ✓ | Bedside PEWS | Canada | 1 | N | N | All inpatients | Uncontrolled before-after study (prospective) | 8 (3 before, 5 after) | 2 (2.4) | 1 (0.43) | RR=0.18 (0.02 to 1.97)† | 0.16† | 23 | |
PICU transfers (per 1000 admissions) | Duns 201466 | ✓ | Between the Flags tool* | Australia | 1 | Y | Y | All inpatients | Uncontrolled before-after study (prospective) | 48 (24 before, 24 after) | 350 (13.1) | 364 (13.1) | RR=1.00 (0.86 to 1.16)† | 0.98 | 7 | |||
Unplanned PICU transfers from ward (per 1000 non-ICU patient-days) | Bonafide 201465 | ✓ | ✓ | Bedside PEWS | USA | 1 | Y | N | All inpatients | Interrupted time series study (prospective) | 59 (32 before, 27 after) | 874 (4.54) | 936 (5.25) | IRR=0.73 (0.46 to 1.14) | 0.16 | 23 | ||
Unplanned transfers to PICU from ward (per 1000 patient-days) | Agulnik 201767 | ✓ | ✓ | Children’s Hospital Cardiac Early Warning Score | Guatemala | 1 | Y | N | Oncology unit | Uncontrolled before-after study (retrospective) | 24 (12 before, 12 after) | 157 (9.3) | 130 (6.5) | RR=0.70 (0.56 to 0.88)† | 0.003 | 19 | ||
Urgent PICU admissions (per 1000 patient-days) | Parshuram 201864 | ✓ | ✓ | ✓ | Bedside PEWS | Belgium, Ireland, The Netherlands, England, Italy, Canada, New Zealand | 21 | Y | N | All inpatients | Cluster randomised trial (prospective) | 18 (6 pre, 12 post) | Con: 652 (4.01) | Con: 1178 (3.83) | RR=0.95 (0.82 to 1.09) | 0.45 | 23 | |
Int: 469 (3.62) | Int: 828 (3.29) | |||||||||||||||||
PICU outcomes | ||||||||||||||||||
Critical deterioration events after PICU transfer (per 1000 non-ICU patient-days) | Bonafide 201465 | ✓ | ✓ | Bedside PEWS | USA | 1 | Y | N | All inpatients | Interrupted time series study (prospective) | 59 (32 before, 27 after) | 260† (1.35) | 282† (1.58) | IRR=0.38 (0.20 to 0.75) | 0.01 | 23 | ||
Mechanical ventilation within 1 hour of unplanned PICU transfer (per unplanned transfer to PICU) | Bonafide 201465 | ✓ | ✓ | Bedside PEWS | USA | 1 | Y | N | All inpatients | Interrupted time series study (prospective) | 59 (32 before, 27 after) | 45 (5.1) | 42 (4.5) | RR=0.87 (0.58 to 1.31)† | 0.51 | 23 | ||
Mechanical ventilation within 12 hours of unplanned PICU transfer (per unplanned transfer to PICU) | Bonafide 201465 | ✓ | ✓ | Bedside PEWS | USA | 1 | Y | N | All inpatients | Interrupted time series study (prospective) | 59 (32 before, 27 after) | 112 (12.8) | 103 (11.0) | IRR=0.17 (0.07 to 0.44) | <0.001 | 23 | ||
Vasopressors within 1 hour of unplanned PICU transfer (per unplanned transfer to PICU) | Bonafide 201465 | ✓ | ✓ | Bedside PEWS | USA | 1 | Y | N | All inpatients | Interrupted time series study (prospective) | 59 (32 before, 27 after) | 41 (4.7) | 16 (1.7) | RR=0.36 (0.21 to 0.64)† | <0.001 | 23 | ||
Vasopressors within 12 hours of unplanned PICU transfer (per unplanned transfer to PICU) | Bonafide 201465 | ✓ | ✓ | Bedside PEWS | USA | 1 | Y | N | All inpatients | Interrupted time series study (prospective) | 59 (32 before, 27 after) | 71 (8.1) | 57 (6.1) | IRR=0.20 (0.06 to 0.62) | 0.006 | 23 | ||
Invasive ventilation in PICU (per emergency PICU admission) | Sefton 201568 | ✓ | ✓ | ✓ | Modified Bristol PEWT (a) | UK | 1 | Y | N | All PICU admissions | Controlled before-after study (retrospective) | 24 (12 before, 12 after) | 118 (75.2) | 104 (62.7) | RR=0.83 (0.72 to 0.97)† | 0.002 | 16 | |
Inotropes in PICU (per emergency PICU admission) | Sefton 201568 | ✓ | ✓ | ✓ | Modified Bristol PEWT (a) | UK | 1 | Y | N | All PICU admissions | Controlled before-after study (retrospective) | 24 (12 before, 12 after) | 50 (31.8) | 40 (24.1) | RR=0.76 (0.53 to 1.08)† | 0.12 | 16 | |
Intubation within 24 hours of PICU admission (per 1000 patient-days) | Agulnik 201767 | ✓ | ✓ | Children’s Hospital Cardiac Early Warning Score | Guatemala | 1 | Y | N | Oncology unit | Uncontrolled before-after study (retrospective) | 24 (12 before, 12 after) | 11 (0.65) | 18 (0.90) | RR=1.38 (0.65 to 2.92)† | 0.46 | 19 | ||
Vasopressors within 24 hours of PICU admission (per 1000 patient-days) | Agulnik 201767 | ✓ | ✓ | Children’s Hospital Cardiac Early Warning Score | Guatemala | 1 | Y | N | Oncology unit | Uncontrolled before-after study (retrospective) | 24 (12 before, 12 after) | 29 (1.72) | 37 (1.86) | RR=1.08 (0.66 to 1.75)† | 0.60 | 19 | ||
Mechanical ventilation during PICU admission (per PICU admission) | Kolovos 201869 | ✓ | ✓ | RRT activation criteria* | USA | 1 | Y | N | All unplanned PICU admissions | Uncontrolled before-after study (retrospective) | 78 (42 before, 36 after) | 285 (25.98) | 233 (22.09) | RR=0.85 (0.73 to 0.99)† | 0.03† | 12 | ||
Intubation within 1 hour of PICU admission (per PICU admission) | Kolovos 201869 | ✓ | ✓ | RRT activation criteria* | USA | 1 | Y | N | All unplanned PICU admissions | Uncontrolled before-after study (retrospective) | 78 (42 before, 36 after) | 49 (4.47) | 88 (8.34) | RR=1.87 (1.33 to 2.62) | 0.0003 | 12 | ||
Significant clinical deterioration events (per 1000 patient-days) | Parshuram 201864 | ✓ | ✓ | ✓ | Bedside PEWS | Belgium, Ireland, The Netherlands, England, Italy, Canada, New Zealand | 21 | Y | N | All inpatients | Cluster randomised trial (prospective) | 18 (6 pre, 12 post) | Con: 144 (0.89) | Con: 259 (0.84) | RR=0.77 (0.61 to 0.97) | 0.03 | 23 | |
Int: 80 (0.62) | Int: 127 (0.50) |
P values in bold denote statistical significance (<0.05).
A critical deterioration event is defined as transfer to the ICU followed by non-invasive or invasive mechanical ventilation or vasopressor infusion within 12 hours.65
*Indicates a PTTT not described or validated in the published literature.
†Data calculated by research team, based on data presented in the journal article. All data calculated via https://www.medcalc.org.
Con, control group; ED, emergency department; ICU, intensive care unit; Int, intervention group; IRR, incident risk ratio; MET, medical emergency team; N/A, not available; PICU, paediatric intensive care unit; PTTT, paediatric track and trigger tool; RR, relative risk; RRT, rapid response team.