title: Systematic review of paediatric track and trigger systems for hospitalised children.
abstract: Early and accurate recognition of the deteriorating hospitalised child is complex. Paediatric track and trigger systems (PTTS) support clinical decision-making by 'tracking' the child's condition through monitoring of clinical signs and 'triggering' a request for an appropriate review when pre-determined criteria are breeched.
  
  
  
  To describe the number and nature of published PTTS and appraise the evidence on their validity, calibration, and effect on important patient outcomes (death, cardiac and/or respiratory arrest, unplanned transfer to intensive/high dependency care, immediate/urgent request for review, rapid response system activation).
  
  
  
  GRADE methodology. Papers identified through electronic database and citation searching.
  
  
  
  Thirty-three PTTS were identified from 55 studies. There was considerable variety in the number and type of parameters, although all contained one or more vital signs. The evidence to support PTTS implementation was very low and the majority of outcomes did not achieve statistical significance. When PTTS was implemented as part of a rapid response system, the evidence was moderate to low but there was some evidence of a statistically significant improvement in outcome.
  
  
  
  There is now some limited evidence for the validity and clinical utility of PTTS scores. The high (and increasing) number of systems is a significant confounder. Further research is needed particularly around the thresholds for the vital signs and the reliability, accuracy and calibration of PTTS in different settings.
authors: Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK; Department of Children's Nursing, London South Bank University, 103 Borough Road, London SE1 0AA, UK. Electronic address: Sue.Chapman@gosh.nhs.uk.
authors: Susan M
authors: SM
authors: Chapman
authors: Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
authors: Jo
authors: J
authors: Wray
authors: Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
authors: Kate
authors: K
authors: Oulton
authors: Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
authors: Mark J
authors: MJ
authors: Peters
mesh_terms: D002648:Child; D002673:Child, Hospitalized; D000066491:Clinical Decision-Making; D003422:Critical Care / Q000379:methods*; D003661:Decision Support Techniques; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D055986:Vital Signs
keywords: Clinical deterioration; Paediatric early warning systems; Paediatric track and trigger systems; Paediatrics; Systematic review