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.

Rapid response systems (RRS) have been widely adopted despite mixed results about their impact in both pediatric and adult settings. This study found a reduction in hospital mortality without a pediatric medical emergency team (PMET). The authors use their findings to illustrate the limitations of before-and-after study designs that previously demonstrated benefits of RRS. These reported benefits in pediatric settings may have resulted from any number of cointerventions rather than adoption of a PMET itself. An accompanying editorial [see link below] further advocates for investments in well-performed studies that can be cost-effective, and appropriately align limited resources to the most proven interventions.