Recognition of Clinical Deterioration in Children

Recognising serious or developing critical illness is an important but complex skill for healthcare professionals caring for children. Unrecognised deterioration in children can lead to avoidable consequences, such as admission to critical care, increased length of stay, cardiac arrest and, sadly, death. Traditional approaches to recognising deterioration have focused on ‘unstructured’ observation and vital sign monitoring. More recently, paediatric track and trigger tools have emerged, which standardised the recording and interpretation of vital signs and support clinician decision-making. Although these can take many forms, they are mainly characterised as scoring or threshold-based systems. These characteristics will be described and compared, and the most frequent component parts are highlighted. The features of effective paediatric track and trigger tools will be presented, and the mechanisms by which these tools may work are emphasised. Criteria to assess if a paediatric track and trigger tool is effective will be considered together with the limitations of their use. Future approaches for recognising deterioration in children will be presented before the chapter is brought to a conclusion.