Chapman, SM; (2017) Paediatric Track and Trigger Systems: Validity, Reliability and Utility. Doctoral thesis , UCL (University College London).

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Abstract

Paediatric Track and Trigger Systems (PTTS) should alert staff to deteriorating children and accelerate access to resuscitation. The thesis presents a series of linked studies exploring selected aspects of PTTS use. Study 1: Systematic review Fifty-five papers describing 33 PTTS were identified. Implemented without a rapid response team (RRT), PTTS did not demonstrate statistically significant relative reduction in cardiac or respiratory arrest, or mortality. Implemented as part of a RRT PTTS demonstrated a statistically significant reduction in the relative and absolute risk of death in hospital, death on the ward and death following PICU transfer. Study 2: Validity This case-controlled study compared the predictive validity of 18 PTTS using case-controlled methodology. The area under the receiver operator characteristic curve (AUROC) varied (0.62 to 0.89). Three systems demonstrated statistically better performance. Incorporation of evidence-based thresholds for heart and respiratory rate did not improve the AUROC of high-performing systems. Study 3: Reliability This study examined the accuracy and completeness of PTTS documentation and compliance to a monitoring and escalation protocol. Of the 13,816 observation sets, 10,518 (76.1%) had an accurately calculated PTTS. Just 4957 (35.9%) contained all the required parameters. Only 3.3% of patients (20/608) met the required standard for monitoring and escalation. Study 4: Utility This mixed-methods study examined the understanding and experiences of children, young people, parents and nurses surrounding the use of a PTTS. Three main themes emerged: benefits and burdens, watchfulness and wisdom, and collaboration and conflict. Findings indicate that use of a PTTS is complex and greater collaboration between children/young people, families and healthcare professionals is likely to improve their use in clinical practice.  Conclusion: There may be a relationship between validity, reliability and utility which, at present, is poorly understood. Better understanding of this relationship may improve outcomes for children and young people

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