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Characteristics of Paediatric Patients Requiring Rapid Response System Activations

Taiki Haga¹, Takaaki Sakaguchi¹, Takuya Matsuda¹

¹Department of Critical Care Medicine, Osaka City General Hospital, 2-13-22, Miyakojima-hondori, Miyakojima, Osaka-city, Osaka, 534-0021, Japan.

International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care

|September 27, 2025

Insights

Paediatric Rapid Response System (RRS) activations are often triggered by respiratory issues. Key indicators for adverse outcomes include low SpO2, low blood pressure, fever, and altered consciousness, guiding RRS protocol optimization.

Area of Science:

Pediatric Critical Care Medicine
Healthcare Systems Analysis
Patient Safety Research

Background:

Paediatric Rapid Response System (RRS) implementation is growing globally.
Characteristics and factors influencing adverse outcomes in paediatric RRS are not well understood.

Purpose of the Study:

To investigate the characteristics of paediatric RRS activations.
To identify factors associated with adverse outcomes in paediatric patients requiring RRS activation.

Main Methods:

Retrospective observational study of paediatric patients (<18 years) across 35 Japanese hospitals (Nov 2017 - June 2022).
Analysis of demographic data, clinical triggers, interventions, and outcomes (ICU transfer, cardiac arrest, death).
Logistic regression used to identify predictors of adverse outcomes.

Main Results:

213 paediatric patients analyzed; median age 47 months.
Most RRS activations (primarily by nurses) were for respiratory issues; 60% involved interventions.
Composite adverse outcome rate was 28.6% (4.7% cardiac arrest, 24.9% ICU admission, 1.9% mortality).
Decreased SpO2, low blood pressure, increased body temperature, altered consciousness, and multiple RRS activation criterion violations/interventions were linked to adverse outcomes.

Conclusions:

Study provides insights into paediatric RRS activation characteristics and adverse outcome predictors.
Findings can inform optimization of paediatric RRS protocols.
Potential to improve paediatric patient safety through enhanced RRS implementation.

Read full analysis

Abstract

Background:

Although paediatric Rapid Response System implementation is gradually increasing worldwide, the characteristics of paediatric Rapid Response Systems and factors associated with adverse outcomes remain underexplored. In this study, we aimed to investigate the characteristics of paediatric Rapid Response Systems and factors associated with adverse outcomes by analysing data from a multicentre Rapid Response System registry in Japan.

Methods:

This retrospective observational study included patients aged <18 years who required Rapid Response System activation across 35 hospitals between November 2017 and June 2022. We analysed demographic data, clinical triggers, interventions, and outcomes, including a primary composite outcome defined as intensive care unit transfer, cardiac arrest, or death following Rapid Response System activation. Logistic regression was used to explore associations between clinical outcomes and various predictors.

Results:

Data of 213 paediatric patients (median age, 47 months) were analysed. Most Rapid Response System activations, primarily initiated by nurses, were for respiratory issues and clinical concerns. Approximately 60% of activations involved interventions. Cardiac arrest, intensive care unit admission, and mortality following Rapid Response System activation occurred in 4.7%, 24.9%, and 1.9% of cases, respectively, resulting in a composite outcome rate of 28.6%. A decreased SpO2, lower blood pressure, increased body temperature, and altered consciousness at the time of Rapid Response System activation were significantly associated with adverse outcomes. Furthermore, multiple violations of the criteria for Rapid Response System activation and multiple interventions were significantly associated with these outcomes.

Conclusion:

This study provides valuable insights into the characteristics of paediatric patients requiring Rapid Response System activation and factors associated with adverse outcomes, which can optimize paediatric Rapid Response System protocols, potentially improving paediatric patient safety.

Keywords:

Child Clinical Deterioration Hospital Rapid Response Team Japan Patient Care Team

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