PMID- 21242527
OWN - NLM
STAT- MEDLINE
DCOM- 20110725
LR  - 20220321
IS  - 2044-5423 (Electronic)
IS  - 2044-5415 (Print)
IS  - 2044-5415 (Linking)
VI  - 20
IP  - 5
DP  - 2011 May
TI  - Description of the development and validation of the Canadian Paediatric Trigger 
      Tool.
PG  - 416-23
LID - 10.1136/bmjqs.2010.041152 [doi]
AB  - OBJECTIVE: To describe the process of developing and validating the Canadian 
      Association of Paediatric Health Centres Trigger Tool (CPTT). METHODS: 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. RESULTS: 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. CONCLUSIONS: The CPTT is the first validated, comprehensive 
      trigger tool available to detect AEs in children hospitalised in acute care 
      facilities.
FAU - Matlow, Anne G
AU  - Matlow AG
AD  - Department of Paediatrics, Hospital for Sick Children, Toronto, Canada. 
      anne.matlow@sickkids.ca
FAU - Cronin, Catherine M G
AU  - Cronin CM
FAU - Flintoft, Virginia
AU  - Flintoft V
FAU - Nijssen-Jordan, Cheri
AU  - Nijssen-Jordan C
FAU - Fleming, Mark
AU  - Fleming M
FAU - Brady-Fryer, Barbara
AU  - Brady-Fryer B
FAU - Hiltz, Mary-Ann
AU  - Hiltz MA
FAU - Orrbine, Elaine
AU  - Orrbine E
FAU - Baker, G Ross
AU  - Baker GR
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Validation Study
DEP - 20110117
PL  - England
TA  - BMJ Qual Saf
JT  - BMJ quality & safety
JID - 101546984
MH  - Adverse Drug Reaction Reporting Systems/*instrumentation
MH  - Canada
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - Medical Errors/*statistics & numerical data
MH  - Pediatrics/*instrumentation
MH  - Reproducibility of Results
MH  - Safety Management/*methods
MH  - Sensitivity and Specificity
PMC - PMC3088437
COIS- Competing interests: None.
EDAT- 2011/01/19 06:00
MHDA- 2011/07/26 06:00
PMCR- 2011/01/17
CRDT- 2011/01/19 06:00
PHST- 2011/01/19 06:00 [entrez]
PHST- 2011/01/19 06:00 [pubmed]
PHST- 2011/07/26 06:00 [medline]
PHST- 2011/01/17 00:00 [pmc-release]
AID - bmjqs.2010.041152 [pii]
AID - qhc41152 [pii]
AID - 10.1136/bmjqs.2010.041152 [doi]
PST - ppublish
SO  - BMJ Qual Saf. 2011 May;20(5):416-23. doi: 10.1136/bmjqs.2010.041152. Epub 2011 
      Jan 17.