Abstract

Objective: The code blue system is an in-hospital early warning and emergency response mechanism designed to ensure rapid and effective intervention in critically deteriorating patients. This study aimed to evaluate the code blue activations implemented in our tertiary pediatric hospital.

Material and Methods: Demographic and clinical data of code blue events recorded between October 2019 and December 2020 at a tertiary pediatric hospital were retrospectively analyzed.

Results: The median age of patients was 146.0 months (IQR: 67.0–183.0), with 23 (39.0%) being male. Underlying chronic conditions were present in 27 patients (45.8%), most commonly neurological (n=9, 33.3%), followed by metabolic/genetic (n=6, 22.2%) and hematologic/oncologic disorders (n=6, 22.2%). Cardiopulmonary resuscitation (CPR) was performed in 10 patients, with a mean duration of 41.25±18.87 minutes (range: 25–60). The return of spontaneous circulation (ROSC) rate among those who received CPR was 90%. There were 4 in-hospital deaths (6.8%) following arrest. Comparison of admitted vs. non-admitted patients revealed that 13 (76.5%) of the admitted group were male (p<0.001), and their median age was significantly lower [67.0 (6.0–184.0) vs. 154.0 (99.5–184.0), p=0.013]. Among admitted patients, 10 (58.8%) were under 73 months of age, and 15 (88.2%) had chronic comorbidities (p<0.001). Code blue calls from pediatric wards resulted in hospital admission in 11 cases (84.6%), whereas 22 calls (52.4%) from phlebotomy units did not require admission (p<0.001).

Conclusion: The high frequency of sudden clinical deterioration among pediatric patients particularly in early childhood and those with chronic conditions emphasizes the critical need for timely and structured in-hospital emergency response. Strengthening code blue teams through early warning systems, continuous training, and structured protocols is essential for improving outcomes and reducing preventable adverse events.

Keywords: Code blue, cardiopulmonary resuscitation, mortality, rapid response team, pediatric, survival

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Copyright © 2025 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Kurt F, Kurt DT. Clinical characteristics and outcomes of pediatric code blue activations in a tertiary care hospital: A retrospective cohort study. Turk J Pediatr Dis. 2025;19(6):351-356. https://doi.org/10.12956/TJPD.2025.1168