Table 4

Forty-seven screening criteria of the preliminary Canadian Association of Paediatric Health Centres Trigger Tool (CPTT)* and positive predictive values for each trigger

Care modulePositive predictive value
 C01Transfusion/use of blood products42.7
 C02Any code or arrest62.5
 C03Unplanned admission (including readmission) as a result of any healthcare management within the 3 months prior to or after discharge from the index hospitalisation26.3
 C04Infection of any kind54.1
 C05In-hospital stroke33.3
 C06Transfer to higher level of care45.8
 C07Catheter infiltration/burn35.3
 C08§Wrong maternal breast milkns
 C09Complication related to central venous catheter61.1
 C10Necrotising enterocolitis66.7
 C11Cranial imaging in infants <3 months38.8
 C12Extreme temperature: ≤35.0°C or ≥41°C35.5
 C13Intubation/reintubation/accidental extubation51.5
 C14Unexpected death80.0
 C15Emergent C-section delivery (neonate only)40.0
 C16Unplanned admission (including readmission) as a result of any healthcare management within the 12 months prior to the index admission23.8
 C17§Unplanned transfer to another acute care hospital (excluding transfers for tests, procedures or specialised care not available at referring hospital)ns
 C18§Inappropriate discharge to home/inadequate discharge plan for Index Hospitalisation (excluding ‘against medical advice’)20.0
 C19Dissatisfaction with care documented in the medical record and/or evidence of complaint lodged (including documented complaint, conflict between patient/family and staff, discharged against medical advice/documentation or correspondence indicating litigation, either contemplated or actual30.0
ICU module
 I01Readmission to ICU33.3
 I02In-unit procedure66.7
 I03Failed intubation83.3
Laboratory module
 L01Abrupt drop >25% Hgb or Hct48.8
Age <1 month WBC <5000/mm e3 (5.0×10 e9/l)
Age 1–23 months WBC <4000/mm e3 (4.0×10 e9/l)
Age 2–18 years WBC <3000/mm e3 (3.0×10 e9/l)
 L03Platelet count < 50 000/mm e3 (50.0×10 e9/l)55.6
 L04PTT>100 s or INR >666.7
 L05d-dimer (positive by local lab normal)62.5
 L06§Glucose <2.8 mmol/l (50 mg/dl)25.0
 L07Sodium: 120 mmol/l >Na >150 mmol/l46.2
 L08Potassium: 3.0 mmol/l >K+ >6.0 mmol/l35.6
 L09Rising BUN/creat >2×baseline68.5
 L10Hypoxia: O2 Sat <75%48.1
 L11Positive blood culture64.3
 L12Gentamicin: (except CF patients); trough >2 mg/l or peak >10 mg/l44.0
Medication module
 M01Vitamin K (excluding newborns)28.6
 M02§Benadryl (diphenhydramine): for symptoms of allergic reaction18.2
 M03§Narcan (naloxone)0.0
 M04§Antiemetic use (for treatment of symptoms)20.0
 M05§Sodium or calcium polystyrene (kayexalate, resonium)ns
 M06Heparin or low-molecular-weight heparin52.4
Surgical module
 S01Unplanned or return to surgery77.8
 S02Intraoperative intravenous epinephrine, norepinephrine, naloxone, flumazenil63.6
 S03§Pathology report normal/unrelated15.0
 S04§Insertion of arterial or central venous line during surgery (excluding CV surgery)25.0
 S05Removal/injury or repair of organ40.0
 S06Wrong site/wrong procedure/wrong patientNS
Other module
 O01Any other undesirable outcome not covered above31.4
  • All other triggers were retained in the final 35-trigger CPTT.

  • * The positive predictive value and ultimate disposition of each trigger are also shown.

  • Screening criterion (trigger) was never selected by nurse reviewers in this sample of 600 cases.

  • Screening criterion C16 merged with C03.

  • § Screening criterion (trigger) with low positive predictive value or not selected removed from CPTT.

  • Wrong site/wrong procedure/wrong patient criterion: a rare event but always associated with an AE and therefore retained despite NS designation.

  • ICU, intensive care unit; Hgb, haemoglobin; Hct, haematocrit; WBC, While blood count; PTT, partial thromboplastin time; INR, international normalised ratio; BUN, blood urea nitrogen; creat, creatinine; CF, cystic fibrosis; CV, cardiovascular.