title: A pragmatic checklist to identify pediatric ICU patients at risk for cardiac arrest or code bell activation.
abstract: BACKGROUND
  In-hospital cardiac arrest is a rare event associated with significant morbidity and mortality. The ability to identify the ICU patients at risk for cardiac arrest could allow the clinical team to prepare staff and equipment in anticipation.
  
  
  METHODS
  This pilot study was completed at a large tertiary care pediatric intensive care unit to determine the feasibility of a simple checklist of clinical variables to predict deterioration. The daily checklist assessed patient risk for critical deterioration defined as cardiac arrest or code bell activation within 24h of the checklist screen. The Phase I checklist was developed by expert consensus and evaluated to determine standard diagnostic test performance. A modified Phase II checklist was developed to prospectively test the feasibility and bedside provider "number needed to train".
  
  
  RESULTS
  For identifying patients requiring code bell activation, both checklists demonstrated a sensitivity of 100% with specificity of 76.0% during Phase I and 97.7% during Phase II. The positive likelihood ratio improved from 4.2 to 43.7. For identifying patients that had a cardiac arrest within 24h, the Phase I and II checklists demonstrated a sensitivity of 100% with specificity again improving from 75.7% to 97.6%. There was an improved positive likelihood ratio from 4.1 in Phase I to 41.9 in Phase II, with improvement of "number needed to train" from 149 to 7.4 providers.
  
  
  CONCLUSIONS
  A novel high-risk clinical indicators checklist is feasible and provides timely and accurate identification of the ICU patients at risk for cardiac arrest or code bell activation.
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Dana E
authors.initials: DE
authors.lastname: Niles
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA, USA. Electronic address: dewanm@chop.edu.
authors.forename: Maya
authors.initials: M
authors.lastname: Dewan
authors.affiliation: Children's Hospital Colorado, Denver, CO, USA.
authors.forename: Carleen
authors.initials: C
authors.lastname: Zebuhr
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Wolfe
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Bonafide
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: DiLiberto
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Boyle
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Napolitano
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Morgan
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Stinson
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Leffelman
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
mesh_terms: D057189:Checklist; D002648:Child; D002675:Child, Preschool; D006323:Heart Arrest / Q000175:diagnosis* / Q000453:epidemiology*; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D010865:Pilot Projects; D011446:Prospective Studies; D018570:Risk Assessment
keywords: Cardiopulmonary resuscitation; Hospital rapid response team; Intensive care units; Pediatric