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Development and initial validation of the Bedside Paediatric Early Warning System score
Christopher S Parshuram1, James Hutchison, Kristen Middaugh
1Department of Critical Care Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. christopher.parshuram@sickkids.ca
Insights
A new 7-item Bedside Paediatric Early Warning System (PEWS) score effectively identifies hospitalized children at risk of critical illness. This tool aids in timely referral to critical care experts, potentially preventing adverse outcomes.
Area of Science:
- Pediatric critical care medicine
- Clinical risk stratification
- Patient safety in hospitals
Background:
- Adverse outcomes in hospitalized children are often preventable.
- Identifying children needing critical care referral is challenging.
- A simple bedside score is needed to assess illness severity.
Purpose of the Study:
- To develop and validate a simple bedside score for quantifying illness severity in hospitalized children.
- To improve the identification of children requiring critical care expertise.
Main Methods:
- A case-control design evaluated 11 candidate items.
- The study involved case-patients urgently admitted to the ICU and control-patients.
- Validation used two prospectively collected datasets.
Main Results:
- The 7-item Bedside Paediatric Early Warning System (PEWS) score (0-26) was developed.
- The area under the ROC curve was 0.91, outperforming nurse ratings (0.84).
- At a score of 8, sensitivity was 82% and specificity was 93%; the score increased before ICU admission.
Conclusions:
- The Bedside PEWS score was developed and initially validated.
- This score quantifies illness severity and identifies critically ill children with advance notice.
- Further prospective validation is needed before widespread clinical use.
Introduction:
Adverse outcomes following clinical deterioration in children admitted to hospital wards is frequently preventable. Identification of children for referral to critical care experts remains problematic. Our objective was to develop and validate a simple bedside score to quantify severity of illness in hospitalized children.
Methods:
A case-control design was used to evaluate 11 candidate items and identify a pragmatic score for routine bedside use. Case-patients were urgently admitted to the intensive care unit (ICU). Control-patients had no 'code blue', ICU admission or care restrictions. Validation was performed using two prospectively collected datasets.
Results:
Data from 60 case and 120 control-patients was obtained. Four out of eleven candidate-items were removed. The seven-item Bedside Paediatric Early Warning System (PEWS) score ranges from 0-26. The mean maximum scores were 10.1 in case-patients and 3.4 in control-patients. The area under the receiver operating characteristics curve was 0.91, compared with 0.84 for the retrospective nurse-rating of patient risk for near or actual cardiopulmonary arrest. At a score of 8 the sensitivity and specificity were 82% and 93%, respectively. The score increased over 24 hours preceding urgent paediatric intensive care unit (PICU) admission (P < 0.0001). In 436 urgent consultations, the Bedside PEWS score was higher in patients admitted to the ICU than patients who were not admitted (P < 0.0001).
Conclusions:
We developed and performed the initial validation of the Bedside PEWS score. This 7-item score can quantify severity of illness in hospitalized children and identify critically ill children with at least one hours notice. Prospective validation in other populations is required before clinical application.
