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Pediatric Early Warning Score and unplanned readmission to the pediatric intensive care unit
Iris M Mandell1, Francine Bynum2, Lori Marshall3
1Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.
Insights
The Pediatric Early Warning Score (PEWS) can help identify children at risk for unplanned Pediatric Intensive Care Unit (PICU) readmission. However, current PEWS scores lack the sensitivity and specificity for clinical use in predicting PICU readmissions.
Area of Science:
- Pediatric critical care medicine
- Clinical risk assessment tools
- Patient safety in pediatrics
Background:
- Early unplanned Pediatric Intensive Care Unit (PICU) readmission is a significant concern, linked to increased length of stay and mortality.
- Currently, no validated tools exist to proactively identify children at high risk for PICU readmission.
- The Pediatric Early Warning Score (PEWS) is used to detect deterioration in ward patients, but its utility for PICU readmission risk is unknown.
Purpose of the Study:
- To evaluate the effectiveness of the Pediatric Early Warning Score (PEWS) in identifying children at risk for unplanned PICU readmission.
- To determine if PEWS scores obtained before PICU discharge or upon ward transfer can predict subsequent PICU readmission.
- To explore the potential of incorporating chronic diagnoses to improve the predictive accuracy of PEWS for PICU readmission.
Main Methods:
- A case-control study was conducted involving 189 children (38 cases of readmission, 151 controls) aged 18 years or younger.
- Data were collected from patients transferred from the PICU to a pediatric ward at an urban tertiary care children's hospital.
- Pediatric Early Warning Scores (PEWS) recorded before PICU discharge and upon initial ward assessment were analyzed for both cases and controls.
Main Results:
- A higher PEWS score was significantly associated with an increased risk of unplanned PICU readmission within 48 hours of transfer.
- Each 1-point increase in PEWS score elevated the odds of PICU readmission (OR 1.6 pre-discharge, OR 1.89 on ward).
- The predictive ability of PEWS for PICU readmission improved when data on chronic diagnoses were included.
Conclusions:
- Elevated PEWS scores correlate with a higher risk of unplanned PICU readmission.
- Current PEWS score cutoffs are not sufficiently sensitive or specific for reliable clinical application in predicting PICU readmission.
- Integrating chronic disease information into PEWS may enhance its clinical utility for identifying at-risk pediatric patients.
Background And Objectives:
Early unplanned Pediatric Intensive Care Unit (PICU) readmission is associated with greater length of stay and mortality. No tools exist to identify children at risk for PICU readmission. The Pediatric Early Warning Score (PEWS) currently identify children at risk for deterioration on the ward. Our primary objective was to evaluate the ability of PEWS to identify children at risk for unplanned PICU readmission.
Methods:
A single-center case-control study of 189 children (38 cases and 151 age-matched controls) 18years or younger transferred from the PICU to the pediatric ward from January 1, 2010-March 30, 2013, at an urban tertiary care children's hospital was conducted.
Results:
Thirty-eight cases had unplanned PICU readmission within 48hours of transfer to pediatric ward, whereas 151 controls were not readmitted. The PEWS assigned prior to PICU discharge and first PEWS assigned on the ward were collected for cases and controls. Each 1-point increase in the PEWS score significantly increased risk of PICU readmission (odds ratios [95% confidence intervals], 1.6 [1.12-2.27; P = .009] and 1.89 [1.33-2.69; P < .001], respectively). Discrimination ability of PEWS for PICU readmission improved when chronic diagnoses were included.
Conclusions:
Higher PEWS scores were associated with increased risk of unplanned PICU readmission. However, cutoff scores are not sensitive or specific enough to be clinically useful. Adding chronic disease variables may improve the clinical utility of cutoff PEWS scores.
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