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Validation of a Paediatric Early Warning Score: first results and implications of usage
Joris Fuijkschot1, Bastiaan Vernhout, Joris Lemson
1Department of Paediatrics, Radboudumc Amalia Children's Hospital, PO box 9101, 6500 HB, Nijmegen, The Netherlands, joris.fuijkschot@radboudumc.nl.
Insights
A modified Paediatric Early Warning Score (PEWS) effectively identifies deteriorating hospitalized children, enabling timely interventions and potentially reducing mortality. This score aids in early recognition without compromising sensitivity compared to existing systems.
Area of Science:
- Pediatric critical care medicine
- Clinical informatics
Background:
- Timely recognition of deterioration in hospitalized children is crucial for improving outcomes.
- Existing pediatric early warning score (PEWS) systems have limitations in sensitivity and specificity.
Purpose of the Study:
- To develop and evaluate a modified PEWS for early identification of critically ill children.
- To assess the effectiveness of the modified PEWS in predicting adverse events.
Main Methods:
- Three cohort studies were conducted using different endpoints.
- A modified PEWS was developed and tested.
- Data were analyzed up to 2 hours prior to the endpoint to assess predictive accuracy.
Main Results:
- The modified PEWS achieved a sensitivity of 0.67 and specificity of 0.88 for predicting unplanned Pediatric Intensive Care Unit (PICU) admission.
- Earlier identification of patients was possible without a loss of sensitivity compared to other PEWS systems.
- A high sensitivity was observed when using the need for emergency medical interventions as an endpoint.
Conclusions:
- The modified PEWS is effective in the early identification of critically ill pediatric patients.
- Early interventions facilitated by the modified PEWS can potentially reduce mortality.
- While some false positives exist, the design prioritizes minimizing false negatives due to the high mortality associated with pediatric resuscitation.
Unlabelled:
Timely recognition of deterioration of hospitalised children is important to improve mortality. We developed a modified Paediatric Early Warning Score (PEWS) and studied the effects by performing three different cohort studies using different end points. Taking unplanned Paediatric Intensive Care Unit admission as end point and only using data until 2 h prior to end point, we found a sensitivity of 0.67 and specificity of 0.88 to timely recognise patients. This proves that earlier identification is possible without a loss of sensitivity compared to other PEWS systems. When determining the corresponding clinical condition in patients with an elevated PEWS dichotomously as 'sick' or 'well', this resulted in a total of 27 % false-positive scores. This can cause motivational problems for caregivers to use the system but is a consequence of PEWS design to minimise false-negative rates because of high mortality associated with paediatric resuscitation. Using the need for emergency medical interventions as end point, sensitivity of PEWS is high and it seems, therefore, that it is also fit to alert health-care professionals that urgent interventions may be needed.
Conclusion:
These data show the effectiveness of a modified PEWS in identifying critically ill patients in an early phase making early interventions possible and hopefully reduce mortality.
