Journal Article

Effect of a pediatric early warning system on all-cause mortality in hospitalized pediatric patients.

Parshuram CS; Dryden-Palmer K; Farrell C; Gottesman R; Gray M; Hutchison JS; Helfaer M; Hunt EA; Joffe AR; Lacroix J; Moga MA; Nadkarni V; Ninis N; Parkin PC; Wensley D; Willan AR; Tomlinson GA; Canadian Critical Care Trials Group; EPOCH Investigators.

Identifying incipient clinical deterioration is a prerequisite for rapid response and prevention of harm for hospitalized patients. This study tested a bedside pediatric early warning system, which included an illness severity score, standardized documentation, and monitoring protocols. In a cluster-randomized trial in several high-income countries, implementation of the bundle did not result in decreased in-hospital mortality compared to usual care. The overall mortality rate in the study was less than 0.2%. The authors suggest that this unexpectedly low mortality rate may have made it difficult to detect differences in intervention versus control hospitals. A related editorial suggests that artificial intelligence should be used to identify clinical deterioration and that outcomes beyond mortality should be considered in their evaluation.