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Extended Research Article
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Track-and-trigger tools do not improve detection of deterioration on their own, but assessing impacts of system-wide change was difficult due to low event rates for hard clinical outcomes.

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Davina Allen 1,*, Amy Lloyd 2, Dawn Edwards 3, Aimee Grant 2, Kerenza Hood 2, Chao Huang 4, Jacqueline Hughes 2, Nina Jacob 2, David Lacy 5, Yvonne Moriarty 2, Alison Oliver 6, Jennifer Preston 7, Gerri Sefton 8, Richard Skone 6, Heather Strange 2, Khadijeh Taiyari 2, Emma Thomas-Jones 2, Robert Trubey 2, Lyvonne Tume 9, Colin Powell 10,11, Damian Roland 12

1 School of Healthcare Sciences, Cardiff University, Cardiff, UK
2 Centre for Trials Research, Cardiff University, Cardiff, UK
3 Children’s Services, Swansea Bay University Health Board, Swansea, UK
4 Hull–York Medical School, University of Hull, Hull, UK
5 Arrowe Park Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
6 Noah’s Ark Children’s Hospital for Wales, Cardiff and Vale University Health Board, Cardiff, UK
7 Alder Hey Clinical Research Facility, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
8 Alder Hey Children’s Hospital, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
9 School of Health and Society, University of Salford, Manchester, UK
10 Department of Emergency Medicine, Sidra Medicine, Doha, Qatar
11 Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
12 Paediatric Emergency Medicine, Leicester Academic (PEMLA) Group, Emergency Department, University of Leicester, Leicester, UK
* Corresponding author Email: allenda@cardiff.ac.uk

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