Consensus-based definition of paediatric out-of-hospital clinical deterioration: a modified delphi study.

BACKGROUND

Paediatric out-of-hospital clinical deterioration (POCD) is rare but carries a high risk of adverse outcomes if not recognised early. Despite its clinical importance, there is no agreed definition of POCD and this conceptual inconsistency limits research comparability and the development of evidence-based prehospital assessment. This study aims to develop an expert consensus-based definition of POCD.

METHODS

A three-round online modified Delphi study was conducted with a multidisciplinary panel of UK clinicians with expertise in paediatric emergency and prehospital care. In Round 1, participants completed open-ended questions to describe and define POCD and propose relevant indicators. In Round 2, participants rated agreement with 14 definition statements synthesised from Round 1 and 21 indicators using a four-point Likert scale. Consensus was predefined as ≥75% agreement. In Round 3, borderline items were rerated, agreed items were confirmed, two indicators were added from Round 2 comments and participants were asked to prioritise the most important five clinical indicators for each paediatric age group.

RESULTS

30 participants participated in Round 1, with 28 completing Round 2 and 26 completing Round 3. Consensus was achieved on a definition describing POCD as 'a progressive or acute worsening of a child's clinical condition over time, identified through observable trends rather than isolated measurements, occurring within a relevant clinical context and carrying a risk of serious adverse outcomes if unrecognised or untreated'. Of the 23 indicators assessed, core indicators consistently prioritised across all age groups were airway patency, respiratory rate, work of breathing, oxygen saturation, skin colour or perfusion and level of consciousness.

CONCLUSION

This study provides the first consensus-based definition of POCD and identifies key indicators to support its recognition in prehospital care. These findings offer a shared conceptual framework to inform future research.