Abstract
<title>Abstract</title> <p>Background Clinical deterioration in hospitalized children outside intensive care settings remains associated with increased morbidity, unplanned PICU admissions and cardiopulmonary arrest. Pediatric Rapid Response Teams (PRRTs) aim to identify and manage early deterioration before progression to critical events. Objective To evaluate trends in PRRT activation and examine its association with Code Blue events in pediatric non-critical care areas of a tertiary care hospital in Karachi, Pakistan, and to assess the effectiveness of PRRT in preventing further clinical deterioration. Methods A retrospective observational study was conducted in pediatric non-critical care areas of a tertiary care hospital in Karachi, Pakistan from January 2024 to December 2025. The study included all admitted paediatric patients (0–18 years) for whom a PRRT activation occurred or a Code Blue event was initiated. Data was extracted from patient medical records and unit-based PRRT and Code Blue databases. PRRT activation was initiated by physicians or nurses using the Pediatric Early Warning Score (PEWS) and PRRT consisted of a PICU fellow, consultant, primary nurse and primary clinical team. Results PRRT activations increased from 346 in 2024 to 503 in 2025, representing a 45.4% increase. In 2025, 223 (44.3%) patients required transfer to PICU while 280 (55.7%) were stabilized and managed within non-critical care units. Respiratory deterioration was the most frequent trigger for PRRT activation (317/503, 63.0%), followed by cardiac causes (80/503, 15.9%), abnormal vital signs/staff concerns and miscellaneous reasons (63/503, 12.5%), and neurological deterioration (43/503, 8.5%).Code Blue events increased from 11 cases in 2024 to 14 cases in 2025. Return of spontaneous circulation (ROSC) improved from 72.7% (8/11) in 2024 to 78.6% (11/14) in 2025. Among Code Blue events in 2025, three patients had PRRT involvement prior to deterioration. Eight arrests occurred secondary to aspiration events during feeding or secretion-related aspiration. One event involved reversal of a previously agreed do-not-resuscitate decision at the time of deterioration and another occurred during chest tube manipulation. Conclusion PRRT utilization increased substantially over the study period with improvement in ROSC following Code Blue events. More than half of PRRT activations were successfully managed without PICU transfer, suggesting a potential role of early recognition and intervention in reducing progression of deterioration. Respiratory deterioration and aspiration-related events remain important targets for quality improvement initiatives.</p>