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Table 2 Outcome of respective trigger in relation to the adverse event sorted by positive predictive value

From: Validation of triggers and development of a pediatric trigger tool to identify adverse events

Original triggers N = 88

n (%) of patients with ≥ 1 of the respective trigger

n of triggers detected by RNs

n of triggers related to AE

PPV, %

Revised triggers N = 29 a

Infiltration/extravasation of intravenous injection/ infusion

40 (6.7)

60

71

100.0

Blood vessel, skin and/or tissue harm

Pressure ulcers

9 (1.5)

14

18

100.0

Blood vessel, skin and/or tissue harm

Urinary retention

9 (1.5)

10

10

100.0

Urinary retention

Positive culture from central line catheter or insertion site

9 (1.5)

10

10

100,0

Positive culture

Clostridium difficile positive stool

5 (0.8)

5

5

100.0

Hospital-acquired infection

Neurological harm

4 (0.7)

5

6

100.0

Neurological impairment/harm

Anesthesia related harm

4 (0.7)

4

4

100.0

Anesthesia-related impairment/harm

Anaphylactic reaction

2 (0.3)

2

3

100,0

Anaphylactic reaction

Ventilator-associated pneumonia

2 (0.3)

2

2

100.0

Ventilator-associated pneumonia

Hallucinations/delirium/ICU syndrome

1 (0.2)

1

1

100.0

Other

Occurrence of any postoperative complication

17 (2.8)

20

19

95.0

Postoperative impairment/harm

Abnormal body temperature

16 (2.7)

19

17

89.5

Abnormal body temperature

Post-operative infection

11 (1.8)

14

12

85.7

Hospital-acquired infection

Other side-effect of drug

34 (5.7)

36

27

75.0

ADE/ADR

Readmission to the Intensive Care Unit

4 (0.7)

4

3

75.0

Unplanned transfer to higher level of care

Skin- and blood vessel harm, thrombophlebitis

100 (16.7)

242

168

69.4

Blood vessel, skin and/or tissue harm

Positive blood culture

30 (5.0)

40

27

67.5

Positive culture

Unplanned drug withdrawal

4 (0.7)

3

2

66.7

ADE/ADR

Change in procedure or technique

7 (1.2)

7

4

57.1

Change in procedure/organ harm

Intubation/reintubation/tracheotomy/ coniotomy

25 (4.2)

36

20

55.6

Intubation, tracheotomy, or coniotomy

Dissatisfaction with care

14 (2.3)

13

7

53.8

Documentation of mistake or dissatisfaction with care

Occurrence of mistake

77 (12.8)

94

50

53.2

Documentation of mistake or dissatisfaction with care

Fungal infection

27 (4.5)

30

15

50.0

Hospital-acquired infection

Reoperation

12 (2.0)

18

9

50.0

Reoperation

Instrumental delivery

16 (2.7)

14

7

50.0

Other

Unplanned removal of and/or harm of an organ during surgery or other invasive action

5 (0.8)

6

3

50.0

Change in procedure/organ harm

Unplanned mechanical ventilation greater than 24 h post-operatively

2 (0.3)

2

1

50.0

Cardiac arrest or failures in vital signs

Naloxone administration

2 (0.3)

2

1

50.0

ADE/ADR

Wound rupture

2 (0.3)

2

1

50.0

Blood vessel, skin and/or tissue harm

Rising serum creatinine

6 (1.0)

10

4

40.0

Renal impairment/harm

Readmission to the ED within 48 hours

4 (0.7)

3

1

33.3

Unplanned readmission within 30 days

Unplanned dialysis

2 (0.3)

3

1

33.3

Renal impairment/harm

Other infection

79 (13.2)

117

38

32.5

Hospital-acquired infection

Aspiration

14 (2.3)

11

3

27.3

Cardiac arrest or failures in vital signs

Pain

127 (21.2)

234

62

26.5

Pain

Unplanned intubation/reintubation/ delayed extubation/CPAP/BiPaP

7 (1.2)

8

2

25.0

Cardiac arrest or failures in vital signs

Apgar < 7

17 (2.8)

17

4

23.5

Decreased vitality in infant

Pneumonia

17 (2.8)

17

4

23.5

Hospital-acquired infection

Readmission within 30 days

81 (13.5)

92

21

22.8

Unplanned readmission within 30 days

Necrotizing enterocolitis

7 (1.2)

9

2

22.2

Necrotizing enterocolitis

Antidote administration

8 (1.3)

14

3

21.4

ADE/ADR

Care: other

71 (11.8)

114

24

21.1

Other

Transfer to higher level of care

28 (4.7)

34

7

20.6

Unplanned transfer to higher level of care

Operative time greater than 6 h

5 (0.8)

5

1

20.0

Other

Antibiotic treated urinary tract infection

16 (2.7)

16

3

18.8

Hospital-acquired infection

Pathological blood gas from umbilical cord blood

12 (2.0)

12

2

16.7

Decreased vitality in infant

Time in ED greater than 6 hours

6 (1.0)

6

1

16.7

Other

Post-operative admission to intensive care unit

6 (1.0)

6

1

16.7

Unplanned transfer to higher level of care

Ultrasound guided drainage

4 (0.7)

6

1

16.7

Hospital-acquired infection

Partial Thromboplastin Time (PTT) greater than 100 seconds

2 (0.3)

7

1

14.3

ADE/ADR

Any codes or arrest

34 (5.7)

96

13

13.5

Cardiac arrest or failures in vital signs

C-reactive protein > 200 mg/liter

25 (4.2)

62

7

11.3

Hospital-acquired infection

Viral gastroenteritis

32 (5.3)

53

6

11.3

Hospital-acquired infection

Abnormal liver enzymes

23 (3.8)

45

4

8.9

ADE/ADR

Abnormal potassium value

18 (3.0)

48

4

8.3

ADE/ADR

Glucose < than 3 mmol/liter or administration of 300 mg/ml or 500 mg/ml glucose

54 (9.0)

154

12

7.8

Hypoglycemia

Vitamin K administration (excluding newborns)

15 (2.5)

44

3

6.8

ADE/ADR

Neutropenia and antibiotic treatment

13 (2.2)

65

4

6.2

Hospital-acquired infection

Abnormal sodium value

17 (2.8)

36

2

5.6

ADE/ADR

Too high or too low drug concentration

14 (2.3)

40

2

5,0

ADE/ADR

Transfusion

72 (12.0)

400

18

4.5

Cardiac arrest or failures in vital signs

Failures in cardiovascular, respiratory or neurological function

114 (19.0)

778

32

4.1

Cardiac arrest or failures in vital signs

Induced delivery

88 (14.7)

90

3

3.3

Other

Abrupt drop in hemoglobin

46 (7.7)

111

3

2.7

Cardiac arrest or failures in vital signs

Thrombocytes < 50 x109/liter

20 (3.3)

87

2

2.3

ADE/ADR

11 triggers not related to an AEb

28 (4.7)

33

0

0.0

 

Total

429 (71.5)

3598

824

22.9

 
  1. RN, registered nurse; AE, adverse events; PPV, positive predictive value; ICU, intensive care unit; ADE, adverse drug event; ADR, adverse drug reaction.
  2. aThe revised trigger column includes the triggers in the final trigger list. For the removed triggers an example of a trigger in the final trigger list suitable for the detection of corresponding AEs is given.
  3. None of the triggers Deep vein thrombosis or embolism, Positive culture from cerebrospinal fluid, Intra- or postoperative death, Post-operative increase in troponin levels, Wrong site/wrong procedure/wrong patient, Flumazenil administration, Sodium polystyrene administration, Interactions, Transfer of mother/child, Terbutaline administration, or 3rd- or 4th-degree lacerations were identified in this study.
  4. bNone of the triggers: International Normalized Ratio (INR) greater > 5, Glucose > 20 mmol/liter, Activation of dose range checking, Intensive care unit procedure, Ultrasound of the brain > week 32 - < 3 months, In-hospital stroke, Falls, Intra-operative administration of administration of inotropes/antidotes, Abnormal pathology report, Unplanned insertion of arterial or central venous line during surgery, Post-operative pleural fluid were associated with an AE in Review Stage 2.