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Table 4 Clinical deterioration events

From: Evaluating processes of care and outcomes of children in hospital (EPOCH): study protocol for a randomized controlled trial

   Definition SCDE*
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
  1. ECMO extracorporeal membrane oxygenation therapy.
  2. *SCDE significant clinical deterioration event.