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Consensus-based definition of paediatric out-of-hospital clinical deterioration: a modified delphi study
Alanowd Alghaith1,2, Tim Coats3, Gregory Adam Whitley4
1School of Medical Sciences - Public Health and Epidemiology Division (SAPPHIRE Group), University of Leicester, Leicester, England, UK asma9@leicester.ac.uk.
Insights
Paediatric out-of-hospital clinical deterioration (POCD) is rare but serious. This study established the first expert consensus definition of POCD and identified key clinical indicators for early recognition in prehospital settings.
Area of Science:
- Emergency Medicine
- Paediatric Care
- Clinical Research
Background:
- Paediatric out-of-hospital clinical deterioration (POCD) lacks a standardized definition, hindering research and evidence-based prehospital care.
- Early recognition of POCD is crucial due to its high risk of adverse outcomes.
Purpose of the Study:
- To develop an expert consensus-based definition for paediatric out-of-hospital clinical deterioration (POCD).
- To identify key clinical indicators for recognizing POCD in prehospital settings.
Main Methods:
- A three-round online modified Delphi study involving UK clinicians specializing in paediatric emergency and prehospital care.
- Consensus was defined as ≥75% agreement on definition statements and clinical indicators.
Main Results:
- A consensus definition of POCD was achieved, emphasizing progressive or acute worsening identified through trends, context, and risk of adverse outcomes.
- Key indicators consistently prioritized across age groups included airway patency, respiratory rate, work of breathing, oxygen saturation, skin perfusion, and level of consciousness.
Conclusions:
- This study presents the first consensus definition of POCD, providing a shared framework for research.
- Identified key indicators will aid in the recognition and management of POCD in prehospital care.
Background:
Paediatric out-of-hospital clinical deterioration (POCD) is rare but carries a high risk of adverse outcomes if not recognised early. Despite its clinical importance, there is no agreed definition of POCD and this conceptual inconsistency limits research comparability and the development of evidence-based prehospital assessment. This study aims to develop an expert consensus-based definition of POCD.
Methods:
A three-round online modified Delphi study was conducted with a multidisciplinary panel of UK clinicians with expertise in paediatric emergency and prehospital care. In Round 1, participants completed open-ended questions to describe and define POCD and propose relevant indicators. In Round 2, participants rated agreement with 14 definition statements synthesised from Round 1 and 21 indicators using a four-point Likert scale. Consensus was predefined as ≥75% agreement. In Round 3, borderline items were rerated, agreed items were confirmed, two indicators were added from Round 2 comments and participants were asked to prioritise the most important five clinical indicators for each paediatric age group.
Results:
30 participants participated in Round 1, with 28 completing Round 2 and 26 completing Round 3. Consensus was achieved on a definition describing POCD as 'a progressive or acute worsening of a child's clinical condition over time, identified through observable trends rather than isolated measurements, occurring within a relevant clinical context and carrying a risk of serious adverse outcomes if unrecognised or untreated'. Of the 23 indicators assessed, core indicators consistently prioritised across all age groups were airway patency, respiratory rate, work of breathing, oxygen saturation, skin colour or perfusion and level of consciousness.
Conclusion:
This study provides the first consensus-based definition of POCD and identifies key indicators to support its recognition in prehospital care. These findings offer a shared conceptual framework to inform future research.
