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A Pilot Study to Validate the Burn Center Pediatric Early Warning Score Tool in Clinical Practice
Zahra H Rahman1, Nicole E Leahy, Kelly Sessler
1From the *Weill Cornell Medical College in Qatar, Doha, Qatar; †New York-Presbyterian Hospital, New York, New York; and ‡Department of Surgery, Weill Cornell Medical College, New York, New York.
Insights
The burn-specific pediatric early warning score (PEWS) effectively detects deterioration in pediatric burn patients. High compliance with PEWS documentation and interventions demonstrates its clinical utility and validation in this population.
Area of Science:
- Pediatric critical care
- Burn injury management
- Clinical assessment tools
Background:
- The pediatric early warning score (PEWS) is crucial for identifying subtle clinical deterioration in non-intensive care unit pediatric patients.
- Limited validation studies exist for PEWS, particularly in burn-injured populations.
- A modified burn-specific PEWS was implemented at New York-Presbyterian/Weill Cornell Medical Center.
Purpose of the Study:
- To investigate the external validity and clinical practice utility of a burn-specific PEWS.
- To assess the documentation compliance and intervention rates following PEWS score changes in pediatric burn patients.
Main Methods:
- Retrospective review of 50 pediatric burn patients (0-15.9 years) with length of stay >3 days.
- Analysis of demographics, total PEWS, score changes, documentation compliance, and interventions.
- Comparison of patients with PEWS > 0 versus PEWS = 0.
Main Results:
- High PEWS documentation rate (92.4%) was observed.
- PEWS increases commonly involved intake/output parameters, leading to interventions in 79.6% of cases.
- Patients with PEWS > 0 had significantly larger burn sizes compared to those with PEWS = 0.
Conclusions:
- The burn-specific PEWS demonstrates high compliance and stimulates timely provider interventions.
- The study supports the validation of the burn-specific PEWS in clinical practice for pediatric burn patients.
- Further research is warranted to evaluate the impact of PEWS on patient outcomes.
Abstract:
The pediatric early warning score (PEWS) tool helps providers to detect subtle clinical deterioration in non-intensive care unit pediatric patients and intervene early to prevent significant adverse outcomes. Although widely used in general pediatrics, limited studies report on its validation; none report on use with burn-injured patients. New York-Presbyterian/Weill Cornell Medical Center modified a general PEWS system to a burn-specific PEWS and integrated its use into standard practice. This study investigated the external validity of the PEWS process in clinical practice. Fifty cases of patients aged 0 to 15.9 years admitted between January 2012 and June 2013, whose length of stay (LOS) more than 3 days were selected for review from this cohort of n equal to 187. Demographics, total PEWS and score changes, and compliance with PEWS documentation and with resultant interventions were reviewed. Continuous variables are presented as mean ± SD, P less than 0.05. Mean age, burn size, and LOS were 3.2 ± 3.3 years, 4.8 ± 5.7%, and 9.8 ± 7.0 days; 26% required grafting, and 50% were male. No mortalities occurred. One thousand six hundred and twelve PEWS from 1745 opportunities were documented (92.4%). For all PEWS (n = 1612) and PEWS greater than 0 (n = 912), means were 0.9 ± 1.2 and 1.6 ± 1.2, respectively. Among the 162 PEWS increase events, intake (54.1%) and output (4.5%) parameters increased most commonly. Of these, 129 PEWS increases (79.6%) were followed by an intervention that most commonly included text notation of score increase (93.7%), physician/physician assistant notification (70.5%), and feeding-tube insertion (25.6%). Patients with PEWS greater than 0 had similar age, LOS, and larger burn size (5.2% vs 1.4%, P < 0.05) than those with PEWS equal to 0. Compliance with PEWS performance and resultant actions based on score increases are high. Data support that even small changes in burn-injury specific PEWS stimulate provider discussion and intervention and support its validation; further studies on its effect on practice are warranted.
