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Validation of the Children's Hospital Early Warning System for Critical Deterioration Recognition
Mary C McLellan1, Kimberlee Gauvreau2, Jean Anne Connor2
1Boston Children's Hospital, Boston, MA, United States.
Insights
The Children's Hospital Early Warning Score (CHEWS) better identifies children at risk for critical deterioration than the Brighton Pediatric Early Warning Score (PEWS). CHEWS offers higher sensitivity and a longer early warning time for timely clinical intervention.
Area of Science:
- Pediatric critical care medicine
- Clinical informatics
- Patient safety
Background:
- Early warning scores are crucial for detecting patient deterioration.
- The Children's Hospital Early Warning Score (CHEWS) and Brighton Pediatric Early Warning Score (PEWS) are used to identify at-risk pediatric patients.
- Validation and comparison of these scores are essential for optimizing patient care.
Purpose of the Study:
- To validate the CHEWS in a pediatric hospital setting.
- To compare the effectiveness of CHEWS against PEWS for early detection of critical deterioration.
- To assess the predictive accuracy and early warning capabilities of both scoring systems.
Main Methods:
- Retrospective cohort study of medical and surgical patients at a quaternary academic pediatric hospital.
- Collected CHEWS and PEWS scores from 360 cases and 776 controls.
- Calculated sensitivity, specificity, AUROC, and early warning times for both scoring tools.
Main Results:
- CHEWS demonstrated a significantly higher AUROC (0.902) compared to PEWS (0.798).
- CHEWS showed higher sensitivity for critical scores (≥5: 75.6% vs. 38.9%) with comparable specificity.
- Early warning time for CHEWS (3.8 hours) was substantially longer than for PEWS (0.6 hours).
Conclusions:
- The CHEWS system exhibits superior performance in discriminating risk for critical deterioration in pediatric patients.
- CHEWS provides a longer lead time for clinical intervention compared to PEWS.
- Findings support the use of CHEWS for enhanced early detection and management of critical illness in hospitalized children.
Objective:
Early warning scores, such as the Children's Hospital Early Warning Score (CHEWS), are used by hospitals to identify patients at risk for critical deterioration and trigger clinicians to intervene and prevent further deterioration. This study's objectives were to validate the CHEWS and to compare the CHEWS to the previously validated Brighton Pediatric Early Warning Score (PEWS) for early detection of critical deterioration in hospitalized, non-cardiac patients at a pediatric hospital.
Design And Methods:
A retrospective cohort study reviewed medical and surgical patients at a quaternary academic pediatric hospital. CHEWS scores and abstracted PEWS scores were obtained on cases (n=360) and a randomly selected comparison sample (n=776). Specificity, sensitivity, area under the receiver-operating characteristic curves (AUROC) and early warning times were calculated for both scoring tools.
Results:
The AUROC for CHEWS was 0.902 compared to 0.798 for PEWS (p<0.001). Sensitivity for scores ≥3 was 91.4% for CHEWS and 73.6% for PEWS with specificity of 67.8% for CHEWS and 88.5% for PEWS. Sensitivity for scores ≥5 was 75.6% for CHEWS and 38.9% for PEWS with specificity of 88.5% for CHEWS and 93.9% for PEWS. The early warning time from critical score (≥5) to critical deterioration was 3.8h for CHEWS versus 0.6h for PEWS (p<0.001).
Conclusion:
The CHEWS system demonstrated higher discrimination, higher sensitivity and longer early warning time than the PEWS for identifying children at risk for critical deterioration.
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