Parental or caregiver intuition may better detect deterioration in pediatric patients

A new study published in The Lancet Child & Adolescent Health journal suggests that parental or caregiver intuition may outperform some traditional early warning systems in identifying children at risk of deterioration. The new analysis found that caregiver concern for worsening condition of pediatric patients was strongly associated with critical illness in pediatric patients admitted to the hospital, even after accounting for abnormal vital signs (abnormal heart rate or abnormal respiratory rate).

In high-income countries critical illness in children is rare, and often difficult for physicians to distinguish from common minor illness until late in the disease. Delayed recognition of deterioration is one of the most common contributing factors to preventable deaths in hospitalized children, and parents or caregivers are often well positioned to detect early and subtle signs of deterioration, but the relationship between their concerns and patient outcomes is unknown, and many healthcare systems are not currently structured to support their involvement in clinical care.

The current study is the first to examine this relationship. It was conducted over 26 months (November 2020 to December 2022) and analyzed 73,845 eligible emergency department presentations of pediatric patients in Australia, with 24,239 having at least one documented response for parent or caregiver concern. The authors assessed caregiver concern by asking the caregiver the question 'Are you worried your child is getting worse?' during routine monitoring. In total, 8,937 (4·7%) respondents out of 189,708 indicated concern for the child's worsening condition.  Compared to patients with caregivers without documented concerns, those with a caregiver reporting concern for clinical deterioration were more likely to experience critical illness requiring admission to ICU (6·9% vs 1·8%) or the need for mechanical ventilation (1·1% vs 0·2%), suggesting that the diagnostic accuracy of the parent's gut feeling outperformed physiological data.

The authors say that their results suggest parents and caregivers are a resource that can assist clinicians to monitor for deterioration, and they may perform better than some current systems reliant on vital signs alone. They say this data suggests that parent or caregiver concerns should be proactively sought, and research which incorporates this into hospital systems used to detect deterioration in pediatric patients should be prioritized.