A modified Delphi study to identify factors associated with clinical deterioration in hospitalized children

Journal article

Objective

Hospitalized children who are admitted to the inpatient ward can deteriorate and require un-planned transfer to the Pediatric Intensive Care Unit. Studies designed to validate early warning scoring systems have focused mainly on abnormalities in vital signs in patients admitted to the inpatient ward. The objective of this study was to determine the patient and system factors that experienced clinicians think are associated with progression to critical illness in hospitalized chil-dren.

Participants and Methods

We conducted a modified Delphi study with three iterations, administered electronically. The expert panel consisted of 11 physician and non-physician health care providers from hospitals in Canada and the United States.

Results

Consensus was reached that 21 of the 57 factors presented are associated with clinical deteriora-tion in hospitalized children. The final list of variables includes patient characteristics, signs and symptoms in the Emergency Department, Emergency Department management, and system fac-tors.

Conclusions

We generated a list of variables that can be used in future prospective studies to determine if they are predictors of clinical deterioration on the inpatient ward.

Authors: Krmpotic, K; Van den Bruel, A; Lobos, A

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: American Academy of Pediatrics
• Journal: Hospital Pediatrics
• Volume: 6
• Issue: 10
• Pages: 616-625
• Publication date: 2016-09-29
• Acceptance date: 2016-08-15
• DOI: 10.1542/hpeds.2016-0006
• EISSN: 2154-1671
• ISSN: 2154-1663
• Pmid: 27686826
• Language: English
• Keywords: hospitalization; humans; prospective studies; female; United States; Delphi technique; infant; disease progression; child; child, hospitalized; risk assessment; Intensive Care Units, pediatric; Canada; emergency service, hospital; male; critical illness; time-to-treatment; early diagnosis