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Measuring Cardiac Autonomic Nervous System (ANS) Activity in Children
Published on: April 29, 2013
Prospective cohort study to test the predictability of the Cardiff and Vale paediatric early warning system
E D Edwards1, C V E Powell, B W Mason
1Department of Paediatrics, Singleton Hospital, Swansea SA2 8QA, UK. Dawn.Edwards@swansea-tr.nhs.wales.uk
Insights
The Cardiff and Vale paediatric early warning score (C&VPEWS) shows high sensitivity in identifying children at risk of critical illness. However, its low specificity means many rapid response team activations would be unnecessary.
Area of Science:
- Pediatric critical care medicine
- Clinical risk prediction
- Patient safety
Background:
- Identifying children at risk of critical illness is challenging.
- Early detection of deterioration is crucial for timely intervention.
- Existing paediatric early warning scores require validation.
Purpose of the Study:
- To develop and validate a paediatric early warning score (PEWS) for predicting critical illness in children.
- To assess the predictive performance of the Cardiff and Vale PEWS (C&VPEWS).
Main Methods:
- Prospective cohort study involving 1000 paediatric admissions.
- Utilized data from the University Hospital of Wales.
- Defined adverse outcomes including cardiorespiratory arrest and critical care admission.
Main Results:
- The C&VPEWS demonstrated 89.0% sensitivity and 63.9% specificity for adverse outcomes.
- The negative predictive value was high at 99.8%, indicating few false negatives.
- The area under the ROC curve was 0.86, suggesting good overall discriminative ability.
Conclusions:
- The C&VPEWS is a sensitive tool for identifying children at risk of critical illness.
- The score's low specificity suggests a high rate of false alarms if used as a sole trigger for rapid response.
- Further refinement may be needed to balance sensitivity and specificity for clinical implementation.
Objective:
To develop and test the predictability of a paediatric early warning score to identify children at risk of developing critical illness.
Design:
Prospective cohort study.
Setting:
Admissions to all paediatric wards at the University Hospital of Wales.
Outcome Measures:
Respiratory arrest, cardiac arrest, paediatric high-dependency unit admission, paediatric intensive care unit admission and death.
Results:
Data were collected on 1000 patients. A single abnormal observation determined by the Cardiff and Vale paediatric early warning system (C&VPEWS) had a 89.0% sensitivity (95% CI 80.5 to 94.1), 63.9% specificity (95% CI 63.8 to 63.9), 2.2% positive predictive value (95% CI 2.0 to 2.3) and a 99.8% negative predictive value (95% CI 99.7 to 99.9) for identifying children who subsequently had an adverse outcome. The area under the receiver operating characteristic curve for the C&VPEWS score was 0.86 (95% CI 0.82 to 0.91).
Conclusion:
Identifying children likely to develop critical illness can be difficult. The assessment tool developed from the advanced paediatric life support guidelines on identifying sick children appears to be sensitive but not specific. If the C&VPEWS was used as a trigger to activate a rapid response team to assess the child, the majority of calls would be unnecessary.
