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Validation of pediatric early warning score in pediatric emergency department
Chanapai Chaiyakulsil1, Uthen Pandee1
1Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
The Pediatric Early Warning Score (PEWS) effectively predicts hospitalization in Thai pediatric emergency departments. This validated tool aids in assessing patient status and identifying those needing intensive care unit admission.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Triage Tools
- Patient Assessment
Background:
- Emergency departments (EDs) are crucial for patient assessment.
- The Pediatric Early Warning Score (PEWS) is a validated tool for EDs, but lacked validation in Thailand.
- This study aimed to validate PEWS for predicting hospitalization in Thai pediatric ED patients.
Purpose of the Study:
- To validate the Pediatric Early Warning Score (PEWS) in predicting hospitalization among children in a Thai emergency department.
- To assess the utility of PEWS as a screening tool for identifying children at risk of admission, including to the ICU.
Main Methods:
- Two phases: initial inter-rater reliability testing (kappa statistic) on 30 pediatric patients, followed by a validation phase with 1136 patients.
- Exclusion criteria: trauma, psychiatric, dental, and surgical cases.
- Validity assessed using Receiver Operating Characteristic (ROC) curves (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
Main Results:
- Good inter-rater reliability for PEWS (kappa = 0.75).
- In the validation phase (n=1136), 14.8% were admitted. AUC for overall admission was 0.73.
- PEWS demonstrated strong predictive value for ICU admission (AUC = 0.98) with high sensitivity (100%) and specificity (91%) at a cut-off of ≥ 3.
Conclusions:
- The Pediatric Early Warning Score (PEWS) demonstrates acceptable validity for assessing pediatric patients in the ED.
- PEWS can serve as an effective screening tool for predicting hospitalization, particularly for identifying children requiring ICU admission.
- This validation supports the use of PEWS in Thai pediatric emergency settings.
Background:
One of the most important functions of the emergency department (ED) is to assess patient status. Only one, the pediatric early warning score (PEWS), has been designed for ED with acceptable validity, but it has never been validated in Thailand. The objective of this study was to validate PEWS in predicting hospitalization in children visiting the ED.
Methods:
During the initial phase, two triage nurses performed blind scoring (in order to determine inter-rater reliability using kappa statistics) for the first 30 patients who presented to the ED at Ramathibodi Hospital between March and May 2014 and who were aged < 15 years. The second phase then consisted of validation and involved 1136 patients. Patients who presented with trauma, psychiatric, dental and surgical concerns were excluded. Validity of the scoring system in predicting admission was assessed using area under the receiver operating characteristics (ROC) curve (AUC), sensitivity, and specificity, positive predictive value (PPV) and negative predictive value (NPV).
Results:
Phase I demonstrated good inter-rater reliability (kappa = 0.75). In phase II, of the total group of 1136 patients, 168 patients (14.8%) were admitted: 162 to the general ward and six to the intensive care unit (ICU) during the study period. AUC for predicting overall, ICU, and general ward admission were 0.73 (95%CI: 0.68-0.77), 0.98 (95%CI: 0.96-1) and 0.71 (95%CI: 0.66-0.75), respectively. The sensitivity and specificity in predicting overall admission with a cut-off of PEWS ≥ 1 was 78% and 60%, respectively (PPV, 28%; NPV, 95%). Sensitivity and specificity in predicting ICU admission with the cut-off PEWS ≥ 3 was 100% and 91%, respectively (PPV, 5%; NPV, 100%). Using the cut-off PEWS ≥ 1, sensitivity and specificity in predicting ward admission were 77% and 59%, respectively (PPV, 24%; NPV, 94%).
Conclusion:
PEWS can be helpful in assessing patient status in pediatric ED with acceptable validity and can serve as a potentially excellent screening tool for prediction of ICU admission.
