Multicentre validation of the bedside paediatric early warning system score: a severity of illness score to detect evolving critical illness in hospitalised children (original) (raw)
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Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2014
The Pediatric Early Warning Score (PEWS) systems were developed to provide a reproducible assessment of a child's clinical status while hospitalized. Most studies investigating the PEWS evaluate its usefulness in the inpatient setting. Limited studies evaluate the effectiveness and integration of PEWS in the pediatric emergency department (ED). The goal of this study was to explore the test characteristics of an ED-assigned PEWS score for intensive care unit (ICU) admission or clinical deterioration in admitted patients. This was a prospective 12-month observational study of patients, aged 0 to 21 years, admitted from the ED of an urban, tertiary care children's hospital. ED nurses were instructed in PEWS assignment and electronic medical record (EMR) documentation. Interrater reliability between nurses was evaluated. PEWS scores were measured at initial assessment (P0) and time of admission (P1). Patients were stratified into outcome groups: those admitted to the ICU either...
Validation of the Pediatric Early Warning Score to determine patient deterioration from illness
Paediatrica Indonesiana, 2016
Background Patients who enter the emergency room (er) present with a variety of conditions, ranging from mild to critical. As such, it may be hard to determine which patients are in need of intensive care unit treatment. The Pediatric Early Warning Score (PeWS) has been used to identify signs of critical illness in pediatric patients. Objective To validate the PeWS system for assessing signs of critical illness in pediatric patients at Dr. mohammad Hoesin Hospital, Palembang. Methods Subjects were children aged 1 month to 18 years who received treatment in the er and Pediatrics Ward in Dr. Mohammad Hoesin Hospital in March to April 2015. Assessment with PeWS was based on vital sign examinations. Scores ranged from 0 to 9. The PEWS was generally taken twice, first in the er, then after 6 hours in the ward. We obtained the cutoff point, sensitivity, and specificity of PeWS, in terms of need for pediatric intensive care unit (PICu) treatment. Results one hundred fifty patients were included in this study. Patients with PeW score of 5 or greater in the er were relatively more likely to be transferred to the PICU, with a sensitivity of 94.4% and a specificity of 82.5%. The cutoff point obtained from the ROC curve was score 4.5 with AUC 96.7% (95%CI 93.4 to 99.9%; P<0.001). Conclusion A PEWS score of cutoff ≥5 may be used to determine which patients are in critically ill condition requiring treatment in PICu.
Intensive Care Medicine, 2010
Unrecognised or untreated clinical deterioration can lead to serious adverse events, including cardiopulmonary arrest and unexpected death. Paediatric alert criteria aim to identify children with early signs of physiological instability that precede clinical deterioration so that experienced clinicians can intervene with the aim of reducing serious adverse events and improving outcome. Purpose: To identify the number and nature of published paediatric alert criteria and evaluate their validity, reliability, clinical effectiveness and clinical utility. Method: Systematic review of studies identified from electronic and citation searching and expert informants. Results: Eleven studies fulfilled the inclusion criteria and described ten paediatric alert criteria. Six studies described the introduction and use of the paediatric alert criteria in practice, four examined the development and testing of the paediatric alert criteria and one described both. There was marked variability across all aspects of the paediatric alert criteria including the method of development, and the number and type of component parameters. Five studies explored the predictive validity of the paediatric alert criteria but only three reported appropriate methodology. Only one study evaluated reliability and none evaluated clinical utility of paediatric alert criteria. Conclusions: Evidence supporting the validity, reliability and utility of paediatric alert criteria is weak. Studies are needed to determine which physiological parameters or combinations of 3 parameters, best predict serious adverse events. Prospective evaluation of validity, reliability and utility is then needed before widespread adoption into clinical practice can be recommended.
Congenital Heart Disease, 2013
Objective. Most inpatient pediatric arrests are preventable by early recognition/treatment of deterioration. Children with cardiac disease have the highest arrest rates; however, early warning scoring systems have not been validated in this population. The objective of this study was to validate the Cardiac Children's Hospital Early Warning Score (C-CHEWS) tool in inpatient pediatric cardiac patients. The associated escalation of care algorithm directs: routine care (score 0-2), increased assessment/intervention (3-4), or cardiac intensive care unit (CICU) consult/transfer (≥5). Design. Sensitivity and specificity were estimated based on retrospective review of patients that experienced unplanned CICU transfer/arrest (n = 64) and a comparison sample (n = 248) of admissions. The previously validated Pediatric Early Warning Score (PEWS) tool was used for comparison. Patients' highest C-CHEWS scores were compared with calculated PEWS scores. Area under the receiver operating characteristic (AUROC) curve was calculated for PEWS and C-CHEWS to measure discrimination. Results. The AUROC curve for C-CHEWS was 0.917 compared with PEWS 0.785 (P < .001). The algorithm AUROC curve was 0.902 vs. PEWS of 0.782. C-CHEWS algorithm sensitivity was 96.9 (score ≥ 2), 79.7 (≥4), and 67.2 (≥5) vs. PEWS of 81.1(≥2), 37.5 (≥4), and 23.4 (≥5). C-CHEWS specificity was 58.1 (≥2), 85.5 (≥4), and 93.6 (≥5) vs. PEWS of 81.1 (≥2), 94.8 (≥4) and 97.6 (≥5). Lead time of elevated C-CHEWS scores (≥2) was a median of 9.25 hours prior to event vs. PEWS, which was 2.25 hours and lead time for critical C-CHEWS scores (≥5) was 2 hours vs. 0 hours for PEWS (P < .001). Conclusions. C-CHEWS has excellent discrimination to identify deterioration in children with cardiac disease and performed significantly better than PEWS both as an ordinal variable and when choosing cut points to maximize AUROC. C-CHEWS has a higher sensitivity than PEWS at all cut points.
The Cardiac Children's Hospital Early Warning Score (C-CHEWS)
Journal of Pediatric Nursing, 2013
Inpatient pediatric cardiovascular patients have higher rates of cardiopulmonary arrests than other hospitalized children. Pediatric early warning scoring tools have helped to provide early identification and treatment to hospitalized children experiencing deterioration thus preventing arrests from occurring. However, the tools have rarely been used and have not been validated in the pediatric cardiac population. This paper describes the modification of a pediatric early warning scoring system for cardiovascular patients, the implementation of the tool, and its companion Escalation of Care Algorithm on an inpatient pediatric cardiovascular unit.
Trials, 2017
Background: Patients' evolving critical illness can be predicted and prevented. However, failure to identify the signs of critical illness and subsequent lack of appropriate action for patients developing acute and critical illness remain a problem. Challenges in assessing whether a child is critically ill may be due to children's often uncharacteristic symptoms of serious illness. Children may seem relatively unaffected until shortly before circulatory and respiratory failure and cardiac arrest. The Bedside Paediatric Early Warning Score has been validated in a large multinational study and is used in two regions in Denmark. However, healthcare professionals experience difficulties in relation to measuring blood pressure and to the lack of assessment of children's level of consciousness. In addition, is it noteworthy that in 23,288-hour studies, all seven items of the Bedside Paediatric Early Warning Score were recorded in only 5.1% of patients. This trial aims to compare two Paediatric Early Warning Score (PEWS) models to identify the better model for identifying acutely and critically ill children. The hypothesis is that the Central Denmark Region PEWS model is superior to the Bedside PEWS in terms of reducing unplanned transfers to intensive care or transfers from regional hospitals to the university hospital among already hospitalised children. Methods/design: This is a multicentre, randomised, controlled clinical trial where children are allocated to one of two different PEWS models. The study involves all paediatric departments and one emergency department in the Central Denmark Region. The primary outcome is unplanned transfer to the paediatric intensive care unit or transfer from regional hospitals to the university hospital. Based on preliminary data, 14,000 children should be included to gain a power of 80% (with a 5% significance level) and to detect a clinically significant difference of 30% of unplanned transfers to intensive care or from regional hospitals to the paediatric department at the university department. A safety interim analysis will be performed after inclusion of 7000 patients. Discussion: This is the first randomised trial to investigate two different PEWS models. This study demonstrates the safety and effectiveness of a new PEWS model and contributes to knowledge of hospitalised children's clinical deterioration.
JAMA, 2018
There is limited evidence that the use of severity of illness scores in pediatric patients can facilitate timely admission to the intensive care unit or improve patient outcomes. To determine the effect of the Bedside Paediatric Early Warning System (BedsidePEWS) on all-cause hospital mortality and late admission to the intensive care unit (ICU), cardiac arrest, and ICU resource use. A multicenter cluster randomized trial of 21 hospitals located in 7 countries (Belgium, Canada, England, Ireland, Italy, New Zealand, and the Netherlands) that provided inpatient pediatric care for infants (gestational age ≥37 weeks) to teenagers (aged ≤18 years). Participating hospitals had continuous physician staffing and subspecialized pediatric services. Patient enrollment began on February 28, 2011, and ended on June 21, 2015. Follow-up ended on July 19, 2015. The BedsidePEWS intervention (10 hospitals) was compared with usual care (no severity of illness score; 11 hospitals). The primary outcome ...
Emergency medicine journal : EMJ, 2015
Designed to detect early deterioration of the hospitalised child, paediatric early warning scores (PEWS) validity in the emergency department (ED) is less validated. We aimed to evaluate sensitivity and specificity of two commonly used PEWS (Brighton and COAST) in predicting hospital admission and, for the first time, significant illness. Retrospective analysis of PEWS data for paediatric ED attendances at St Mary's Hospital, London, UK, in November 2012. Patients with missing data were excluded. Diagnoses were grouped: medical and surgical. To classify diagnoses as significant, established guidelines were used and, where not available, common agreement between three acute paediatricians. 1921 patients were analysed. There were 211 admissions (11%). 1630 attendances were medical (86%) and 273 (14%) surgical. Brighton and COAST PEWS performed similarly. hospital admission: PEWS of ≥3 was specific (93%) but poorly sensitive (32%). The area under the receiver operating curve (AUC) ...
Pediatric Early Warning Scores (PEWS) Tool Implementation
2021
The aim of this quality improvement project was to facilitate the implementation of the Pediatric Early Warning System (PEWS) in a general pediatric unit. Background: Various illnesses can affect a child's health condition. When a child becomes ill, especially with a respiratory illness, they are at risk of deteriorating quickly. Children who are sick need to be monitored closely, so signs and symptoms of distress can be caught early before a child's condition deteriorates or even dies. Assessment skills are crucial in identifying deterioration and changes in a child's health status. A child on the decline requires prompt intervention to prevent unexpected death. There are benefits to early referral and recognition of respiratory distress signs, the key to timely care. Consequently, the nurse needs a clear understanding of the difference between distress and normal physiology in the child, so that essential and appropriate care can be implemented, leading to positive out...