SynthesisBMJ open2019
Optimising paediatric afferent component early warning systems: a hermeneutic systematic literature review and model development.
Synthesis in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Supporting translation of research evidence into practice-the use of Normalisation Process Theory to assess and inform implementation within randomised controlled trials: a systematic review.Implementation science : IS · 2023Pooled it
- Technical Approaches to Predicting Acute Deterioration in Pediatric Inpatients: Protocol for a Scoping Review.JMIR research protocols · 2026Article
- Evaluating the Scale-Up and Sustainability of the Paediatric ESCALATION System in Country Western Australia: A Multi-Methods Study.The Australian journal of rural health · 2026Article
- [Early warning scores: a rapid umbrella review].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Review
- Development, implementation and evaluation of an evidence-based paediatric early warning system improvement programme: the PUMA mixed methods study.BMC health services research · 2022Article
- Article
- Predicting Patient Deterioration: A Review of Tools in the Digital Hospital Setting.Journal of medical Internet research · 2021Review
- First do no harm: practitioners' ability to 'diagnose' system weaknesses and improve safety is a critical initial step in improving care quality.Archives of disease in childhood · 2021Article
- Wavelet Transform Artificial Intelligence Algorithm-Based Data Mining Technology for Norovirus Monitoring and Early Warning.Journal of healthcare engineering · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors.
Funding
Abstract
objectiveTo identify the core components of successful early warning systems for detecting and initiating action in response to clinical deterioration in paediatric inpatients.
methodsA hermeneutic systematic literature review informed by translational mobilisation theory and normalisation process theory was used to synthesise 82 studies of paediatric and adult early warning systems and interventions to support the detection of clinical deterioration and escalation of care. This method, which is designed to develop understanding, enabled the development of a propositional model of an optimal afferent component early warning system.
resultsDetecting deterioration and initiating action in response to clinical deterioration in paediatric inpatients involves several challenges, and the potential failure points in early warning systems are well documented. Track and trigger tools (TTT) are commonly used and have value in supporting key mechanisms of action but depend on certain preconditions for successful integration into practice. Several supplementary interventions have been proposed to improve the effectiveness of early warning systems but there is limited evidence to recommend their wider use, due to the weight and quality of the evidence; the extent to which systems are conditioned by the local clinical context; and the need to attend to system component relationships, which do not work in isolation. While it was not possible to make empirical recommendations for practice, the review methodology generated theoretical inferences about the core components of an optimal system for early warning systems. These are presented as a propositional model conceptualised as three subsystems: detection, planning and action.
conclusionsThere is a growing consensus of the need to think beyond TTTs in improving action to detect and respond to clinical deterioration. Clinical teams wishing to improve early warning systems can use the model to consider systematically the constellation of factors necessary to support detection, planning and action and consider how these arrangements can be implemented in their local context. PROSPERO REGISTRATION NUMBER: CRD42015015326.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.