Paediatric out-of-hospital clinical deterioration: A scoping review

Children often have signs of clinical and physiological instability before cardiopulmonary arrest. Early recognition of these signs is crucial for facilitating timely interventions and preventing irreversible outcomes. Paediatric Out-of-Hospital Clinical Deterioration (POCD) has previously been poorly described. This scoping review aims to examine the literature describing predictors, barriers and facilitators associated with recognising deteriorating children in the prehospital setting and to identify gaps that may inform future research. A scoping review was conducted following the Joanna Briggs Institute methodology and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. MEDLINE, EMBASE, CINAHL, Scopus and Web of Science were searched for English-language studies published from January 1990 to February 2026. Eligible studies included children (≤18 years) managed by prehospital clinicians and examined deterioration, severity of illness, assessment tools, predictive approaches or factors influencing recognition. Two reviewers independently screened all citations. One reviewer extracted data using a structured framework, and a second reviewer verified a sample of the extracted data for accuracy. Twenty-eight studies met inclusion criteria, most using retrospective quantitative design and originating from high-income countries. No study provided an operational or standardised definition of POCD. Research primarily focused on physiological predictors, trauma-specific indices and the application of hospital-derived early warning scores in prehospital care. Few studies explored barriers or facilitators to early recognition. Most studies relied on single time-point physiological measurements. No study evaluated physiological trajectories as predictors of deterioration outcomes. In conclusion, the absence of a standardised definition of POCD, variation in outcome measures and reliance on single-measurement physiological predictors limit comparability across studies and hinder the development of consistent approaches to recognising deterioration in prehospital paediatric care. Future research should focus on establishing a consensus definition of POCD, incorporating temporal physiological trends and understanding factors that influence the implementation of paediatric early warning systems in prehospital setting.