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Evidence-based paediatric nursing: paediatric early warning systems
1Certified in paediatrics, Bambino Gesù Children's Hospital (BGCH) IRCCS.
Insights
Pediatric in-hospital cardiac arrests are rare but have poor outcomes. Recognizing early signs of clinical deterioration in children can prevent cardiac arrest and improve survival rates.
Area of Science:
- Pediatric critical care medicine
- Hospital patient safety
Background:
- In-hospital cardiac arrest in children is infrequent but associated with poor outcomes, including high mortality and neurological impairment.
- A significant proportion of unexpected pediatric deaths in hospitals are preventable.
Purpose of the Study:
- To review the incidence and outcomes of pediatric in-hospital cardiac arrest.
- To identify factors contributing to missed clinical deterioration preceding cardiac arrest in children.
Main Methods:
- Review of pediatric mortality data and patient records.
- Analysis of clinical deterioration signs preceding cardiac arrest events.
Main Results:
- Clear signs of clinical deterioration are often present up to 24 hours before a pediatric cardiac arrest.
- Preventable factors, such as missed deterioration, contribute to adverse outcomes.
Conclusions:
- Timely recognition and intervention for clinical deterioration are crucial for preventing pediatric cardiac arrest.
- Improved staff situational awareness and communication are essential to mitigate risks associated with missed deterioration.
Abstract:
In hospital cardiac arrest are rare events in paediatrics. Most children receive appropriate care without experiencing undetected severe clinical deterioration during hospital admission. Outcomes of paediatric cardiac arrests are however generally poor, with high mortality rates and neurological damage at survival. A review of child mortality in the UK showed that a high proportion of unexpected deaths were preventable ( Pearsons 2008 ). Several studies of patient records of children who suffered cardiac arrests showed the presence of clear signs of clinical deterioration up to 24 hours before (Tume 2006). Appropriate recognition of clinical deterioration could have led to timely intervention to stabilise the patient. Missed deterioration may be due to lack of staff situational awareness, communication failure among professionals or between staff and families and other human factors ( Brady 2014 ).
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