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

Parshuram CS, Dryden-Palmer K, Farrell C, et al; Canadian Critical Care Trials Group and EPOCH Investigators. JAMA. 2018 Feb 27; [Epub ahead of print].

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.

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