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Systematic review of paediatric alert criteria for identifying hospitalised children at risk of critical deterioration

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Unrecognised or untreated clinical deterioration can lead to serious adverse events, including cardiopulmonary arrest and unexpected death. Paediatric alert criteria aim to identify children with early signs of physiological instability that precede clinical deterioration so that experienced clinicians can intervene with the aim of reducing serious adverse events and improving outcome.


To identify the number and nature of published paediatric alert criteria and evaluate their validity, reliability, clinical effectiveness and clinical utility.


Systematic review of studies identified from electronic and citation searching and expert informants.


Eleven studies fulfilled the inclusion criteria and described ten paediatric alert criteria. Six studies described the introduction and use of the paediatric alert criteria in practice, four examined the development and testing of the paediatric alert criteria, and one described both. There was marked variability across all aspects of the paediatric alert criteria, including the method of development, and the number and type of component parameters. Five studies explored the predictive validity of the paediatric alert criteria, but only three reported appropriate methodology. Only one study evaluated reliability, and none evaluated clinical utility of paediatric alert criteria.


Evidence supporting the validity, reliability and utility of paediatric alert criteria is weak. Studies are needed to determine which physiological parameters or combinations of parameters, best predict serious adverse events. Prospective evaluation of validity, reliability and utility is then needed before widespread adoption into clinical practice can be recommended.

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Some of this work was undertaken at University College London Hospital–University College London Comprehensive Biomedical Research Centre, which received a proportion of funding from the United Kingdom Department of Health’s National Institute for Health Research Biomedical Research Centres funding scheme.

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Correspondence to Susan M. Chapman.

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Chapman, S.M., Grocott, M.P.W. & Franck, L.S. Systematic review of paediatric alert criteria for identifying hospitalised children at risk of critical deterioration. Intensive Care Med 36, 600–611 (2010).

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