Development and evaluation of a German Paediatric Trigger Tool (PAED-TT-GER) for detecting adverse events in hospitalized children

Abstract

Abstract Trigger tools (TTs) are highly recommended for structured detection of adverse events (AEs) through retrospective medical record review. However, available general tools require thorough adaptation to paediatric care and local documentation practices to ensure feasibility and reliable AE identification. The aim of this study was to develop a German Paediatric Trigger Tool (PAED-TT-GER) and evaluate its feasibility, applicability, and interrater reliability in a paediatric cardiology inpatient setting, and to describe the characteristics of AEs detected. We conducted a single-centre, retrospective methodological study on a paediatric cardiology general ward at a tertiary university hospital in Germany. PAED-TT-GER was developed in a stepwise process: (1) literature-based trigger extraction, (2) interdisciplinary expert consensus and contextual adaptation, (3) refinement of standardized operational definitions, and (4) pilot testing and interrater reliability assessment. In the main application, 200 electronic inpatient records (inclusion criteria: age < 18 years; length of stay ≥ 24 h; discharge ≥ 30 days before review) were screened. Records with identified triggers underwent secondary physician review to confirm AEs. AE severity was classified using NCC MERP (E–I), and preventability was rated using an established, six-point scale. From an initial pool of 145 candidate triggers, 57 triggers were selected (54 for general wards plus 3 supplementary triggers for potential PICU use). Interrater reliability testing in 27 records showed good agreement (ICC 0.794; 95% CI 0.557–0.906). In the main study cohort with 200 patients, 472 triggers were identified in sum (mean 2.36 per record; range 0–13). A total of 45 AEs were confirmed in 42/200 records (21.0%). Most AEs caused temporary harm requiring intervention (NCC MERP E, 24/45) or prolonged hospitalization (F, 19/45); two events resulted in permanent harm (G, 2/45). Seven AEs (15.6%) were rated as preventable after chart review. Conclusion : PAED-TT-GER is a feasible and reliable instrument for detecting AEs in hospitalized children within a German paediatric context. It enables systematic harm measurement and provides a foundation for paediatric patient safety surveillance and future validation across additional paediatric subspecialties and care settings. What Is Known: • Trigger tools enable structured retrospective detection of adverse events in paediatric inpatient care, but their applicability depends on adaptation to paediatric populations and specific healthcare and documentation contexts. What Is New: • The newly developed German Paediatric Trigger Tool (PAED-TT-GER), comprising 54 general-ward triggers and three supplementary PICU triggers, demonstrated good interrater reliability in a paediatric cardiology setting.