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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.