Early warning tools to identify children at risk of deterioration: a discussion

Abstract

SC IE N C E P H O TO L IB R A R Y Being able to identify children at risk of clinical deterioration in ward settings and facilitate a timely referral to intensive care is clearly important. Paediatric ‘early warning tools’ to assess risk are beginning to emerge in the UK, based on extensive adult experience with such tools (Buist et al 2002, Goldhill et al 1999, Odell et al 2002, Ridley and Leary 2003, Subbe et al 2001). These tools have the potential to optimise patient outcomes, improve quality of care and reduce the length of ITU stay with its associated costs. However, there is a need for caution in the development of these early warning tools: the paediatric team cannot just modify adult tools without any primary research or audit data on their use in children. In this article we argue that although these tools are likely to be very useful, they must be developed from primary audit and research data as there are key physiological differences between adults and children. Scoring tools need to be validated properly to ensure that they do in fact identify children at risk, and any resultant benefits need to be measured.