Causes, characteristics and improvement strategies for delayed interventions during paediatric deterioration: A mixed methods systematic review

IF 5.1 2区医学 Q1 NURSING

Intensive and Critical Care Nursing Pub Date : 2026-04-01 Epub Date: 2026-01-19 DOI:10.1016/j.iccn.2025.104330

Shannon Cresham Fox , Takawira C. Marufu , Emma Popejoy , Nicola Taylor , Damien Roland , Joseph C. Manning

{"title":"Causes, characteristics and improvement strategies for delayed interventions during paediatric deterioration: A mixed methods systematic review","authors":"Shannon Cresham Fox , Takawira C. Marufu , Emma Popejoy , Nicola Taylor , Damien Roland , Joseph C. Manning","doi":"10.1016/j.iccn.2025.104330","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Children are susceptible to deterioration due to compensatory mechanisms. Timely recognition and intervention are strongly associated with improved clinical outcomes, whereas delays elevate mortality risk. Failure to rescue (FtR), the inability to prevent death following deterioration, represents a critical safety concern, yet contributory factors and contextual characteristics remain inadequately synthesised.</div></div><div><h3>Aim</h3><div>Identify and evaluate causes, characteristics and improvement strategies associated with delayed intervention during paediatric clinical deterioration in hospitalised children.</div></div><div><h3>Methods</h3><div>A mixed-methods systematic review of five databases was conducted including studies on hospitalised children (0–18 years) reporting outcomes related to FtR (e.g. mortality), published after 2000. Rigour was ensured through PROSPERO registration (CRD420250651864) and appraisal checklists. Data were analysed using a convergent segregated approach.</div></div><div><h3>Results</h3><div>Fifty-two studies included 820,000 hospitalised children and 4.4 million clinical events were synthesised. Qualitative and quantitative findings resulted in three themes: recognition, escalation and response, with qualitative findings presenting insight into barriers associated with each stage (including unclear escalation pathways and training gaps). Whilst quantitative findings reported prevalence of delayed recognition, escalation and response with pervasive organisational factors contributing to delays (e.g. staffing). Younger children and children with medical complexity (CMC) were at increased risk, and global majority populations were disproportionately affected. Integrated synthesis showed delays stem from individual, organisational, and systemic factors, while experienced nurses play a critical role in timely intervention.</div></div><div><h3>Conclusion</h3><div>Individual, organisational and systemic factors contribute to delayed intervention. CMC and global majority populations were disproportionately affected. Findings highlight critical points of delay. Reporting participant characteristics (e.g. ethnicity, medical complexity) is essential to understand their impact upon deterioration pathways.</div></div><div><h3>Implications for clinical practice</h3><div>Nurses are pivotal in recognising and responding to deterioration, and should recognise high-risk groups. Awareness should translate into advocacy for early intervention.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104330"},"PeriodicalIF":5.1000,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Intensive and Critical Care Nursing","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0964339725003921","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/1/19 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Children are susceptible to deterioration due to compensatory mechanisms. Timely recognition and intervention are strongly associated with improved clinical outcomes, whereas delays elevate mortality risk. Failure to rescue (FtR), the inability to prevent death following deterioration, represents a critical safety concern, yet contributory factors and contextual characteristics remain inadequately synthesised.

Aim

Identify and evaluate causes, characteristics and improvement strategies associated with delayed intervention during paediatric clinical deterioration in hospitalised children.

Methods

A mixed-methods systematic review of five databases was conducted including studies on hospitalised children (0–18 years) reporting outcomes related to FtR (e.g. mortality), published after 2000. Rigour was ensured through PROSPERO registration (CRD420250651864) and appraisal checklists. Data were analysed using a convergent segregated approach.

Results

Fifty-two studies included 820,000 hospitalised children and 4.4 million clinical events were synthesised. Qualitative and quantitative findings resulted in three themes: recognition, escalation and response, with qualitative findings presenting insight into barriers associated with each stage (including unclear escalation pathways and training gaps). Whilst quantitative findings reported prevalence of delayed recognition, escalation and response with pervasive organisational factors contributing to delays (e.g. staffing). Younger children and children with medical complexity (CMC) were at increased risk, and global majority populations were disproportionately affected. Integrated synthesis showed delays stem from individual, organisational, and systemic factors, while experienced nurses play a critical role in timely intervention.

Conclusion

Individual, organisational and systemic factors contribute to delayed intervention. CMC and global majority populations were disproportionately affected. Findings highlight critical points of delay. Reporting participant characteristics (e.g. ethnicity, medical complexity) is essential to understand their impact upon deterioration pathways.

Implications for clinical practice

Nurses are pivotal in recognising and responding to deterioration, and should recognise high-risk groups. Awareness should translate into advocacy for early intervention.

查看原文本刊更多论文

儿童病情恶化时延迟干预的原因、特点和改进策略：一项混合方法系统综述。

背景：由于代偿机制的存在，儿童易发生神经退化。及时识别和干预与改善临床结果密切相关，而延迟则会增加死亡风险。抢救失败（FtR），即无法预防病情恶化后的死亡，是一个严重的安全问题，但促成因素和背景特征仍未得到充分综合。目的：识别和评估住院儿童临床恶化期间延迟干预的原因、特征和改善策略。方法：对5个数据库进行混合方法系统评价，包括2000年以后发表的关于报告FtR相关结果（如死亡率）的住院儿童（0-18岁）的研究。通过PROSPERO注册（CRD420250651864）和评估清单确保了严谨性。数据分析使用收敛分离的方法。结果：52项研究包括82万住院儿童和440万临床事件。定性和定量研究结果产生了三个主题：认识、升级和反应，定性研究结果对每个阶段相关的障碍（包括不明确的升级途径和培训差距）提出了见解。同时，定量调查结果报告了延迟识别、升级和反应的普遍性，以及导致延迟的普遍组织因素（例如人员配备）。年龄较小的儿童和患有医疗复杂性（CMC）的儿童的风险增加，全球大多数人口受到不成比例的影响。综合综合显示延迟源于个人，组织和系统因素，而经验丰富的护士在及时干预中发挥关键作用。结论：个体因素、组织因素和系统因素导致延迟干预。CMC和全球大多数人口受到不成比例的影响。研究结果突出了延迟的关键点。报告参与者特征（如种族、医疗复杂性）对于了解其对恶化途径的影响至关重要。对临床实践的启示：护士在识别和应对恶化是关键的，应该认识到高危人群。认识应转化为倡导早期干预。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Intensive and Critical Care Nursing NURSING-

CiteScore

6.30

自引率

15.10%

发文量

144

审稿时长

57 days

期刊介绍： The aims of Intensive and Critical Care Nursing are to promote excellence of care of critically ill patients by specialist nurses and their professional colleagues; to provide an international and interdisciplinary forum for the publication, dissemination and exchange of research findings, experience and ideas; to develop and enhance the knowledge, skills, attitudes and creative thinking essential to good critical care nursing practice. The journal publishes reviews, updates and feature articles in addition to original papers and significant preliminary communications. Articles may deal with any part of practice including relevant clinical, research, educational, psychological and technological aspects.