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Can paediatric early warning score be used as a triage tool in paediatric accident and emergency?
1Homerton University Hospital, London, UK. katebradman@hotmail.co.uk
Insights
The UK paediatric early warning score (PEWS) can help identify children unlikely to need hospital admission when used in accident and emergency triage. However, it has limited value in predicting which children require admission.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Triage Tools
- Patient Risk Stratification
Background:
- The UK paediatric early warning score (PEWS) was designed for inpatients to identify children at risk of HDU/PICU admission.
- Accident and Emergency (A&E) departments face strain due to the '4-h wait' policy, necessitating rapid patient assessment and admission.
Purpose of the Study:
- To evaluate the utility of the PEWS score as a triage tool in A&E.
- To determine if PEWS can expedite the admission process for pediatric patients.
Main Methods:
- A retrospective audit of 424 pediatric patients (aged 0-16) attending A&E between Oct 1-16, 2006.
- Calculation of sensitivity and specificity for PEWS scores in predicting hospital admission.
Main Results:
- A PEWS score of ≥4 had 24% sensitivity and 96% specificity for admission.
- A PEWS score of ≥2 had 37% sensitivity and 88% specificity.
- A low PEWS score (<2) demonstrated high specificity, indicating a low likelihood of admission.
Conclusions:
- PEWS has limited value for predicting admission in an undifferentiated A&E population.
- A low PEWS score (<2) is a reliable indicator that a child is unlikely to require hospital admission.
Abstract:
The UK paediatric early warning score (PEWS) was developed for inpatients, looking at admission to the HDU and PICU and trying to produce a system which would recognize those children at risk of admission. Since the introduction of the '4-h wait', accident and emergency (A&E) departments have been under increasing strain to assess, treat and admit patients (if required) as quickly as possible. We designed this study with the view of identifying if the PEWS score could be used as a triage tool, to detect those patients who will need admission and therefore speed up the process of admitting children to the ward. All patients who visited A&E from 1st October-16th October 2006 were audited. The PEWS scores were collated after the study period. 774 children attended A&E during the study period. 316 patients were sent home from triage following nurse-led treatment or sent to another facility. Of the 458 patients remaining, 424 (93%) were included in the study - the only exclusion criterion was the failure of complete documentation of observations. The sensitivity [the probability of a child being admitted with a score of (n)] and the specificity (the probability of a patient not being admitted with a score of 0) were calculated. For all children aged 0-16 years, a PEWS score of >or=4 had a sensitivity of 24% and a specificity of 96%. A PEWS score of >or=2 had a sensitivity of 37% and a specificity of 88%. PEWS is of limited value in predicting admission (in a triage setting) in a population of undifferentiated disease. However, a low PEWS score has a high specificity, that is, a patient scoring <2 is unlikely to need admission.
