Related Experiment Video
Updated: Mar 16, 2026
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Systematic review of paediatric track and trigger systems for hospitalised children
Susan M Chapman1, Jo Wray2, Kate Oulton2
1Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK; Department of Children's Nursing, London South Bank University, 103 Borough Road, London SE1 0AA, UK.
Insights
Paediatric track and trigger systems (PTTS) show limited evidence for validity and clinical utility. While many systems exist, further research is needed to optimize their use in improving patient outcomes.
Area of Science:
- Pediatric critical care
- Clinical decision support systems
- Health services research
Background:
- Early recognition of deteriorating hospitalized children is challenging.
- Paediatric track and trigger systems (PTTS) aid clinical decisions by monitoring vital signs and triggering reviews.
- Numerous PTTS variations exist, complicating implementation and evaluation.
Purpose of the Study:
- To catalog published PTTS and assess their evidence base.
- To evaluate the validity, calibration, and impact of PTTS on patient outcomes.
- To identify research gaps in PTTS development and application.
Main Methods:
- Systematic literature search and appraisal using GRADE methodology.
- Identification and characterization of 33 distinct PTTS from 55 studies.
- Analysis of evidence for PTTS validity, calibration, and effect on patient outcomes.
Main Results:
- Significant heterogeneity observed in PTTS parameters, though all included vital signs.
- Evidence supporting PTTS implementation was generally of very low quality.
- When integrated into rapid response systems, PTTS showed moderate to low evidence of improved outcomes.
Conclusions:
- Limited evidence supports the validity and clinical utility of current PTTS.
- The proliferation of PTTS poses a challenge to consistent application and research.
- Further research is crucial for optimizing PTTS thresholds, reliability, accuracy, and calibration across diverse settings.
Context:
Early and accurate recognition of the deteriorating hospitalised child is complex. Paediatric track and trigger systems (PTTS) support clinical decision-making by 'tracking' the child's condition through monitoring of clinical signs and 'triggering' a request for an appropriate review when pre-determined criteria are breeched.
Objective:
To describe the number and nature of published PTTS and appraise the evidence on their validity, calibration, and effect on important patient outcomes (death, cardiac and/or respiratory arrest, unplanned transfer to intensive/high dependency care, immediate/urgent request for review, rapid response system activation).
Method:
GRADE methodology. Papers identified through electronic database and citation searching.
Results:
Thirty-three PTTS were identified from 55 studies. There was considerable variety in the number and type of parameters, although all contained one or more vital signs. The evidence to support PTTS implementation was very low and the majority of outcomes did not achieve statistical significance. When PTTS was implemented as part of a rapid response system, the evidence was moderate to low but there was some evidence of a statistically significant improvement in outcome.
Conclusion:
There is now some limited evidence for the validity and clinical utility of PTTS scores. The high (and increasing) number of systems is a significant confounder. Further research is needed particularly around the thresholds for the vital signs and the reliability, accuracy and calibration of PTTS in different settings.
More Related Videos
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:26Pharmaceutical Poisoning: Potential Scenarios
01:29Drug Dosing: Infants and Children