{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T11:31:40Z","timestamp":1784633500652,"version":"3.55.0"},"reference-count":23,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2012,4,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVES:<\/jats:title>\n                  <jats:p>Standard metrics for evaluating rapid response systems (RRSs) include cardiac and respiratory arrest rates. These events are rare in children; therefore, years of data are needed to evaluate the impact of RRSs with sufficient statistical power. We aimed to develop a valid, pragmatic measure for evaluating and optimizing RRSs over shorter periods of time.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>We reviewed 724 medical emergency team and 56 code-blue team activations in a children\u2019s hospital between February 2010 and February 2011. We defined events resulting in ICU transfer and noninvasive ventilation, intubation, or vasopressor infusion within 12 hours as \u201ccritical deterioration.\u201d By using in-hospital mortality as the gold standard, we evaluated the test characteristics and validity of this proximate outcome metric compared with a national benchmark for cardiac and respiratory arrest rates, the Child Health Corporation of America Codes Outside the ICU Whole System Measure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>Critical deterioration (1.52 per 1000 non-ICU patient-days) was more than eightfold more common than the Child Health Corporation of America measure of cardiac and respiratory arrests (0.18 per 1000 non-ICU patient-days) and was associated with &amp;gt;13-fold increased risk of in-hospital death. The critical deterioration metric demonstrated both criterion and construct validity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>The critical deterioration rate is a valid, pragmatic proximate outcome associated with in-hospital mortality. It has great potential for complementing existing patient safety measures for evaluating RRS performance.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2011-2784","type":"journal-article","created":{"date-parts":[[2012,3,6]],"date-time":"2012-03-06T04:16:41Z","timestamp":1331007401000},"page":"e874-e881","source":"Crossref","is-referenced-by-count":85,"title":["Development of a Pragmatic Measure for Evaluating and Optimizing Rapid Response Systems"],"prefix":"10.1542","volume":"129","author":[{"given":"Christopher P.","family":"Bonafide","sequence":"first","affiliation":[{"name":"Division of General Pediatrics,"},{"name":"Center for Pediatric Clinical Effectiveness, and"},{"name":"Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania;"},{"name":"Leonard Davis Institute of Health Economics and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn E.","family":"Roberts","sequence":"additional","affiliation":[{"name":"Departments of Nursing and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret A.","family":"Priestley","sequence":"additional","affiliation":[{"name":"Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen M.","family":"Tibbetts","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics,"},{"name":"GfK Healthcare, Blue Bell, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics,"},{"name":"School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinay M.","family":"Nadkarni","sequence":"additional","affiliation":[{"name":"Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron","family":"Keren","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics,"},{"name":"Center for Pediatric Clinical Effectiveness, and"},{"name":"Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania;"},{"name":"Leonard Davis Institute of Health Economics and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2012,4,1]]},"reference":[{"issue":"4","key":"2021120903562097300_B1","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.resuscitation.2009.12.008","article-title":"\u201cIdentifying the hospitalised patient in crisis\u201d\u2014a consensus conference on the afferent limb of rapid response systems.","volume":"81","author":"DeVita","year":"2010","journal-title":"Resuscitation"},{"key":"2021120903562097300_B2","unstructured":"Institute for Healthcare Improvement. 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