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Development and evaluation of a German Paediatric Trigger Tool (PAED-TT-GER) for detecting adverse events in
Anthea Peters1, Isabel Schulz2, Nicole Müller2
1Department of Paediatric Cardiology, University Hospital, Bonn University, Bonn, Germany. anthea.peters@ukbonn.de.
Insights
The German Paediatric Trigger Tool (PAED-TT-GER) is a reliable method for identifying adverse events in hospitalized children. This tool enhances patient safety surveillance in German pediatric care.
Area of Science:
- Pediatric Patient Safety
- Healthcare Quality Improvement
- Medical Record Review
Background:
- Trigger tools (TTs) are vital for structured adverse event (AE) detection via retrospective medical record review.
- Existing general TTs require adaptation for pediatric care and local documentation practices to ensure feasibility and reliability.
- The German Paediatric Trigger Tool (PAED-TT-GER) was developed to address these limitations in the German pediatric context.
Purpose of the Study:
- To develop and evaluate the feasibility, applicability, and interrater reliability of the German Paediatric Trigger Tool (PAED-TT-GER).
- To describe the characteristics of adverse events detected using PAED-TT-GER in a pediatric cardiology inpatient setting.
Main Methods:
- A retrospective methodological study was conducted in a tertiary university hospital's pediatric cardiology ward in Germany.
- PAED-TT-GER was developed through literature-based trigger extraction, interdisciplinary expert consensus, and refinement of operational definitions.
- 200 electronic inpatient records were screened; identified triggers led to secondary physician review for AE confirmation. AE severity and preventability were assessed.
Main Results:
- A total of 57 triggers were selected for PAED-TT-GER (54 general ward, 3 PICU supplementary).
- Interrater reliability testing showed good agreement (ICC 0.794).
- In 200 patient records, 45 AEs were confirmed in 42 patients (21.0%), with most causing temporary harm or prolonged hospitalization. Seven AEs (15.6%) were preventable.
Conclusions:
- PAED-TT-GER is a feasible and reliable instrument for detecting AEs in hospitalized children within the German healthcare system.
- The tool facilitates systematic harm measurement and supports pediatric patient safety surveillance.
- Further validation across diverse pediatric subspecialties and care settings is recommended.
Abstract:
Trigger tools (TTs) are highly recommended for structured detection of adverse events (AEs) through retrospective medical record review. However, available general tools require thorough adaptation to paediatric care and local documentation practices to ensure feasibility and reliable AE identification. The aim of this study was to develop a German Paediatric Trigger Tool (PAED-TT-GER) and evaluate its feasibility, applicability, and interrater reliability in a paediatric cardiology inpatient setting, and to describe the characteristics of AEs detected. We conducted a single-centre, retrospective methodological study on a paediatric cardiology general ward at a tertiary university hospital in Germany. PAED-TT-GER was developed in a stepwise process: (1) literature-based trigger extraction, (2) interdisciplinary expert consensus and contextual adaptation, (3) refinement of standardized operational definitions, and (4) pilot testing and interrater reliability assessment. In the main application, 200 electronic inpatient records (inclusion criteria: age < 18 years; length of stay ≥ 24 h; discharge ≥ 30 days before review) were screened. Records with identified triggers underwent secondary physician review to confirm AEs. AE severity was classified using NCC MERP (E-I), and preventability was rated using an established, six-point scale. From an initial pool of 145 candidate triggers, 57 triggers were selected (54 for general wards plus 3 supplementary triggers for potential PICU use). Interrater reliability testing in 27 records showed good agreement (ICC 0.794; 95% CI 0.557-0.906). In the main study cohort with 200 patients, 472 triggers were identified in sum (mean 2.36 per record; range 0-13). A total of 45 AEs were confirmed in 42/200 records (21.0%). Most AEs caused temporary harm requiring intervention (NCC MERP E, 24/45) or prolonged hospitalization (F, 19/45); two events resulted in permanent harm (G, 2/45). Seven AEs (15.6%) were rated as preventable after chart review.
Conclusion:
PAED-TT-GER is a feasible and reliable instrument for detecting AEs in hospitalized children within a German paediatric context. It enables systematic harm measurement and provides a foundation for paediatric patient safety surveillance and future validation across additional paediatric subspecialties and care settings.
What Is Known:
• Trigger tools enable structured retrospective detection of adverse events in paediatric inpatient care, but their applicability depends on adaptation to paediatric populations and specific healthcare and documentation contexts.
What Is New:
• The newly developed German Paediatric Trigger Tool (PAED-TT-GER), comprising 54 general-ward triggers and three supplementary PICU triggers, demonstrated good interrater reliability in a paediatric cardiology setting.
