A Modified Delphi Study to Identify Factors Associated With Clinical Deterioration in Hospitalized Children.
Hospitalized children who are admitted to the inpatient ward can deteriorate and require unplanned transfer to the PICU. Studies designed to validate early warning scoring systems have focused mainly on abnormalities in vital signs in patients admitted to the inpatient ward. The objective of this study was to determine the patient and system factors that experienced clinicians think are associated with progression to critical illness in hospitalized children.



We conducted a modified Delphi study with 3 iterations, administered electronically. The expert panel consisted of 11 physician and nonphysician health care providers from hospitals in Canada and the United States.



Consensus was reached that 21 of the 57 factors presented are associated with clinical deterioration in hospitalized children. The final list of variables includes patient characteristics, signs and symptoms in the emergency department, emergency department management, and system factors.



We generated a list of variables that can be used in future prospective studies to determine if they are predictors of clinical deterioration on the inpatient ward.
Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, St. John's, Canada; Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada; kristina.krmpotic@easternhealth.ca.
Kristina
K
Krmpotic
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
Ann
A
Van den Bruel
Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; and Faculty of Medicine, University of Ottawa, Ottawa, Canada.
Anna-Theresa
AT
Lobos
D002170:Canada / Q000453:epidemiology; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data; D016638:Critical Illness / Q000453:epidemiology / Q000628:therapy; D003697:Delphi Technique; D018450:Disease Progression; D042241:Early Diagnosis; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D061665:Time-to-Treatment / Q000592:standards / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology