Department of Paediatrics, Hospital for Sick Children, Toronto, Canada.
BMJ Qual Saf. 2011 May;20(5):416-23. doi: 10.1136/bmjqs.2010.041152. Epub 2011 Jan 17.
To describe the process of developing and validating the Canadian Association of Paediatric Health Centres Trigger Tool (CPTT).
Five existing trigger tools were consolidated with duplicate triggers eliminated. After a risk analysis and modified Delphi process, the tool was reduced from 94 to 47 triggers. Feasibility of use was tested, reviewing 40 charts in three hospitals. For validation, charts were randomly selected across four age groups, half medical/half surgical diagnoses, from six paediatric academic health sciences centres. 591 charts were reviewed by six nurses (for triggers and adverse events (AEs)) and three physicians (for AEs only). The incidence of trigger- and AE-positive charts was documented, and the sensitivity and specificity of the tool to identify charts with AEs were determined. Identification of AEs by nurses and physicians was compared. The positive predictive value (PPV) of each trigger was calculated and the ratio of false- to true-positive AE predictors analysed for each trigger.
Nurses rated the CPTT easy to use and identified triggers in 61.1% (361/591; 95% CI 57.2 to 65.0) of patient charts; physicians identified AEs in 15.1% (89/ 591, 95% CI 0.23 to 0.43). Over a third of patients with AEs were neonates. The sensitivity and specificity were 0.88 and 0.44, respectively. Nurse and physician AE assessments correlated poorly. The PPV for each trigger ranged from 0 to 88.3%. Triggers with a false/true-positive ratio of >0.7 were eliminated, resulting in the final 35-trigger CPTT.
The CPTT is the first validated, comprehensive trigger tool available to detect AEs in children hospitalised in acute care facilities.
描述加拿大儿科保健中心触发工具（CPTT）的开发和验证过程。
合并了 5 种现有的触发工具，去除了重复的触发因素。经过风险分析和修改后的 Delphi 流程，该工具的触发因素从 94 个减少到 47 个。在三个医院中对 40 份病历进行了使用可行性测试。为了验证，从六个儿科学术卫生科学中心随机选择了四个年龄组的一半医疗/一半手术诊断的病历。六名护士（用于触发因素和不良事件（AE））和三名医生（仅用于 AE）审查了 591 份病历。记录了触发因素和 AE 阳性病历的发生率，并确定了该工具识别 AE 病历的敏感性和特异性。比较了护士和医生对 AE 的识别。计算了每个触发因素的阳性预测值（PPV），并分析了每个触发因素的假阳性和真阳性 AE 预测因子的比值。
护士认为 CPTT 使用方便，在 591 份病历中的 61.1%（361/591；95%CI 57.2%至 65.0%）中识别出了触发因素；医生在 591 份病历中识别出了 15.1%（89/591，95%CI 0.23 至 0.43）的 AE。三分之一以上的 AE 患者是新生儿。敏感性和特异性分别为 0.88 和 0.44。护士和医生的 AE 评估相关性较差。每个触发因素的 PPV 范围为 0 至 88.3%。虚假/真实阳性比>0.7 的触发因素被删除，最终得到了 35 个触发因素的 CPTT。
CPTT 是第一个经过验证的全面触发工具，可用于检测在急症护理设施住院的儿童的 AE。
