Related Experiment Video
Updated: Mar 14, 2026
Identification and Quantification of Deranged Metabolites in Critically Ill Patients Using NMR-Based Metabolomics
Published on: November 29, 2024
A Modified Delphi Study to Identify Factors Associated With Clinical Deterioration in Hospitalized Children
Kristina Krmpotic1, Ann Van den Bruel2, Anna-Theresa Lobos3
1Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, St. John's, Canada; Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada; kristina.krmpotic@easternhealth.ca.
Insights
Experienced clinicians identified 21 patient and system factors linked to clinical deterioration in hospitalized children. This list will inform future studies on predicting critical illness progression in pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Clinical informatics
Background:
- Hospitalized children may deteriorate, necessitating unplanned pediatric intensive care unit (PICU) transfers.
- Existing early warning scoring systems primarily focus on vital sign abnormalities in general pediatric wards.
Purpose of the Study:
- To identify patient and system factors associated with clinical deterioration in hospitalized children, as perceived by experienced clinicians.
- To develop a comprehensive list of variables for future research on predicting critical illness.
Main Methods:
- A modified Delphi study involving 3 electronic iterations.
- An expert panel of 11 physicians and non-physicians from Canadian and US hospitals.
Main Results:
- Consensus was achieved on 21 out of 57 presented factors associated with clinical deterioration.
- Key factors encompass patient characteristics, emergency department signs/symptoms, ED management, and system-level influences.
Conclusions:
- A validated list of variables was generated for future prospective studies.
- These variables aim to predict clinical deterioration in hospitalized children on general inpatient wards.
Objective:
Hospitalized children who are admitted to the inpatient ward can deteriorate and require unplanned transfer to the PICU. 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 children.
Methods:
We conducted a modified Delphi study with 3 iterations, administered electronically. The expert panel consisted of 11 physician and nonphysician 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 deterioration in hospitalized children. The final list of variables includes patient characteristics, signs and symptoms in the emergency department, emergency department management, and system factors.
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.