RESEARCH ARTICLE A Modified Delphi Study to Identify Factors Associated With Clinical Deterioration in Hospitalized Children Kristina Krmpotic, MD, FRCPC, a,b Ann Van den Bruel, MD, PhD, c Anna-Theresa Lobos, MD, FRCPC d,e ABSTRACT OBJECTIVE: Hospitalized children who are admitted to the inpatient ward can deteriorate and require unplanned transfer to the PICU. Studies designed to validate early warning scoring systems have focused mainly on abnormalities in vital signs in patients admitted to the inpatient ward. The objective of this study was to determine the patient and system factors that experienced clinicians think are associated with progression to critical illness in hospitalized children. METHODS: We conducted a modified Delphi study with 3 iterations, administered electronically. The expert panel consisted of 11 physician and nonphysician health care providers from hospitals in Canada and the United States. RESULTS: Consensus was reached that 21 of the 57 factors presented are associated with clinical deterioration in hospitalized children. The final list of variables includes patient characteristics, signs and symptoms in the emergency department, emergency department management, and system factors. CONCLUSIONS: We generated a list of variables that can be used in future prospective studies to determine if they are predictors of clinical deterioration on the inpatient ward. a Department of Pediatrics, Janeway Children’s Health and Rehabilitation Centre, St. John’s, Canada; b Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Canada; c Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom; d Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Canada; and e Faculty of Medicine, University of Ottawa, Ottawa, Canada www.hospitalpediatrics.org DOI:10.1542/hpeds.2016-0006 Copyright © 2016 by the American Academy of Pediatrics Address correspondence to Kristina Krmpotic, MD, FRCPC, Pediatric Intensive Care, Janeway Children’s Health and Rehabilitation Centre, 300 Prince Phillip Dr, St. John’s, Newfoundland and Labrador, A1B 3V6, Canada. E-mail: kristina.krmpotic@easternhealth.ca HOSPITAL PEDIATRICS (ISSN Numbers: Print, 2154-1663; Online, 2154-1671). FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. FUNDING: No external funding. POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. Dr Krmpotic conceptualized and designed the study and data collection instruments, coordinated and supervised data collection, carried out the initial analyses, and drafted the initial manuscript; Drs Van den Bruel and Lobos contributed to study design, assisted with survey design and analysis, and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted. 616 KRMPOTIC et al by guest on June 11, 2020 http://hosppeds.aappublications.org/ Downloaded from