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Sensitivity of the pediatric early warning score to identify patient deterioration
Mari Akre1, Marsha Finkelstein, Mary Erickson
1Children's Hospitals and Clinics of Minnesota, Clinical Nursing Administration, 910 East 26th St, Suite 40-420, Minneapolis, MN 55403, USA. mari.akre@childrensmn.org
Insights
The Pediatric Early Warning Score (PEWS) can provide over 11 hours of forewarning for patient deterioration, enabling timely interventions and potentially preventing Rapid Response Team (RRT) events or codes.
Area of Science:
- Pediatric critical care medicine
- Patient safety and monitoring
Background:
- The Pediatric Early Warning Score (PEWS) is utilized to identify deteriorating patients on general pediatric wards.
- Early detection of patient decline is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To evaluate the sensitivity of PEWS as an early indicator of patient deterioration leading to a Rapid Response Team (RRT) or code event.
- To determine the extent of staff awareness of patient deterioration prior to an RRT/code event.
- To compare the timing of critical PEWS with other indicators of deterioration.
Main Methods:
- Retrospective analysis of 170 non-ICU RRT and 16 code events.
- PEWS was calculated at 4-hour intervals for 24 hours preceding each event.
- The PEWS algorithm, with a critical score of ≥4 or a single domain score of 3, was applied.
Main Results:
- A critical PEWS preceded deterioration in 85.5% of patients, with a median forewarning of 11 hours 36 minutes.
- Consultations occurred a median of 80 minutes prior to the event for 97.1% of patients.
- Oximetry was added for 43.5% of patients, a median of 6.9 hours before the event.
Conclusions:
- PEWS demonstrates potential for providing significant forewarning (>11 hours) of patient deterioration.
- Early PEWS alerts can facilitate timely care plan adjustments, potentially averting RRT or code events.
- Integrating PEWS with other clinical assessments may enhance early recognition of critical changes.
Objective:
We evaluated the Pediatric Early Warning Score (PEWS) sensitivity as an early indicator of patients deterioration leading to a Rapid Response Team (RRT)/code event. We hypothesized that at least 80% of patients had a critical PEWS preceding the event. We determined staff awareness of deterioration in patient status prior to the event as evidenced by consults, addition of monitoring equipment or increased frequency of assessment. The timing of these events was compared to critical PEWS times.
Methods:
One hundred and seventy non-ICU RRT and 16 code events were identified between October 2006 and February 2008. We completed retrospective PEWS at four-hour intervals or less for twenty-four hours preceding the event. The PEWS algorithm, guiding staff to consult at a critical score > or =4 or a single domain score equal to 3, was applied.
Results:
For 85.5% of patients the earliest indicator of deterioration, evidenced by a critical PEWS, was a median of 11 hours 36 minutes and the earliest preceding the event was 30 minutes. For 97.1% of patients the earliest median time to a consult was 80 minutes. Oximetry was added 6.9 hours for 43.5% of patients. 7% of patients had increased nursing assessment. A sub-group of patients had 1) critical PEWS, 2) consult and 3) addition of a monitor. The median time for earliest critical PEWS for these was significant (P < 0.001).
Conclusion:
PEWS can potentially provide a forewarning time >11 hours, alerting the team to adapt the care plan and possibly averting an RRT or code.
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