Table 4 Clinical deterioration events

1

Early transfer

<60 ml/kg intravenous or intraosseous fluid resuscitation given in the 12 h before transfer, no intravenous or intraosseous inotrope or vasoactive medications and no positive pressure ventilation (bag mask or endotracheal) in the 12 h before transfer

No

2

Noninvasive respiratory support

Positive pressure ventilation in the 12 h before transfer, but not intubated at the time of transfer. This category includes children receiving mask-delivered positive airway pressure at any stage in the 12 h before transfer and at the time of transfer. Mechanical ventilation during anesthesia for a scheduled procedure is not included

No

3

Invasive respiratory support

Intubated and/or receiving endotracheal ventilation at the time of transfer or intubated within 1 h of PICU admission

Yes

4

Circulatory

>60 ml/kg intravenous or intraosseous fluid resuscitation given in the 12 h before transfer, and administration of any intravenous or intraosseous inotrope or vasopressor at the time of transfer or at any stage in the 12 h preceding transfer. Patients in this category may also receive positive pressure ventilation (2)

Yes

5

Late transfer

Respiratory (3) and circulatory (4) support before transfer

Yes

6

Cardiopulmonary resuscitation

Chest compressions before transfer from ward area or within 1 h of PICU admission or ECMO instituted before or within 1 h of PICU admission

Yes

7

Death

Death on an inpatient ward, other than in those patients with DNR orders. Death may occur despite CPR (or intention to perform CPR if patient is pronounced dead without CPR). No transfer from ward area

Yes