Acute Crit Care.  2023 Nov;38(4):498-506. 10.4266/acc.2023.01354.

Eleven years of experience in operating a pediatric rapid response system at a children’s hospital in South Korea

• Jeon YH
• Lee B
• Kim YS
• Jang WJ
• Park JD

• KMID: 2550906
• DOI: http://doi.org/10.4266/acc.2023.01354

Abstract

Background
Various rapid response systems have been developed to detect clinical deterioration in patients. Few studies have evaluated single-parameter systems in children compared to scoring systems. Therefore, in this study we evaluated a single-parameter system called the acute response system (ARS).
Methods
This retrospective study was performed at a tertiary children’s hospital. Patients under 18 years old admitted from January 2012 to August 2023 were enrolled. ARS parameters such as systolic blood pressure, heart rate, respiratory rate, oxygen saturation, and whether the ARS was activated were collected. We divided patients into two groups according to activation status and then compared the occurrence of critical events (cardiopulmonary resuscitation or unexpected intensive care unit admission). We evaluated the ability of ARS to predict critical events and calculated compliance. We also analyzed the correlation between each parameter that activates ARS and critical events.
Results
The critical events prediction performance of ARS has a specificity of 98.5%, a sensitivity of 24.0%, a negative predictive value of 99.6%, and a positive predictive value of 8.1%. The compliance rate was 15.6%. Statistically significant increases in the risk of critical events were observed for all abnormal criteria except low heart rate. There was no significant difference in the incidence of critical events.
Conclusions
ARS, a single parameter system, had good specificity and negative predictive value for predicting critical events; however, sensitivity and positive predictive value were not good, and medical staff compliance was poor.

Keyword

cardiac arrest; early warning score; hospital rapid response team; intensive care units; pediatrics

Figure

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  Figure 1. Flowchart of the study. The acute response system (ARS) activation group indicates that medical staff activated ARS during vital sign measurements, regardless of whether the criteria for ARS were met. The ARS non-activation group refers to cases where medical staff did not activate ARS during vital sign measurements, regardless of whether the criteria for ARS were met. ICU: intensive care unit; ED: emergency department.

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  Figure 2. The annual changes in the number of critical events. The annual trends based on whether the acute response system (ARS) was activated within 48 hours of a critical event. Cardiopulmonary resuscitation (CPR) event (A) and unexpected pediatric intensive care unit (PICU) admission (B). ARS was divided into an ARS activation group and a non-activation group according to whether ARS was activated within 48 hours prior to the occurrence of critical events.

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  Figure 3. Effectiveness of the acute response system (ARS) and compliance with ARS activation. The ability to predict critical events by activating ARS in the real ward (A) and calculated compliance of the system (B). The ability of the ARS to predict critical events (C). Success in prediction is considered a critical event, defined as an unexpected pediatric intensive care unit admission or cardiopulmonary resuscitation event, occurring within 48 hours of ARS activation. NPV: negative predictive value; PPV: positive predictive value.

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