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Evaluation of a Pediatric Early Warning Score Across Different Subspecialty Patients
Nathan P Dean1, J B Fenix, Michael Spaeder
11Division of Critical Care Medicine, Children's National Health System, Washington, DC. 2Division of Critical Care Medicine, George Washington School of Medicine, Washington, DC. 3Department of Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 4Division of Pediatric Critical Care Medicine, University of Virginia School of Medicine, Charlottesville, VA.
Insights
A Pediatric Early Warning Score effectively predicts patient deterioration across various pediatric subspecialties, signaling the need for intensive care unit transfer and interventions. This score aids in timely clinical decision-making for critically ill children.
Area of Science:
- Pediatric critical care medicine
- Clinical risk stratification
- Patient safety
Background:
- Pediatric Early Warning Scores (PEWS) are used to identify at-risk children.
- The predictive ability of PEWS may vary across different pediatric subspecialty populations.
- Standardizing PEWS utility is crucial for improving patient outcomes.
Purpose of the Study:
- To assess the effectiveness of a Pediatric Early Warning Score in predicting clinical deterioration.
- To evaluate PEWS performance in distinct pediatric subspecialty groups.
- To determine the association between PEWS and the need for intensive care unit (ICU) interventions.
Main Methods:
- Retrospective cohort study at a single tertiary children's hospital.
- Patients categorized into cardiac, hematology/oncology/bone marrow transplant, surgical, neurologic, and general medical groups.
- Analysis of the relationship between PEWS and unplanned ICU transfer within 12 hours, requiring specific ICU therapies.
Main Results:
- Area under the curve (AUC) for PEWS ranged from 0.88 (surgical) to 0.94 (cardiac).
- Sensitivities varied by PEWS threshold and patient group, with PEWS ≥ 3 showing 75-94% sensitivity.
- Number needed to evaluate ranged from 3.5 to 43, indicating varying efficiency in identifying deterioration.
Conclusions:
- An elevated Pediatric Early Warning Score is significantly associated with ICU transfer and receipt of critical care interventions.
- PEWS demonstrates predictive value across diverse pediatric subspecialty populations.
- PEWS can aid in early identification of deteriorating pediatric patients requiring advanced care.
Objective:
To evaluate the ability of a Pediatric Early Warning Score to predict deterioration in different subspecialty patient populations.
Design:
Single center, retrospective cohort study. Patients were classified into five groups: 1) cardiac; 2) hematology/oncology/bone marrow transplant; 3) surgical; 4) neurologic; and 5) general medical. The relationship between the Pediatric Early Warning Score and unplanned ICU transfer requiring initiation of specific ICU therapies (intubation, high-flow nasal cannula, noninvasive ventilation, inotropes, or aggressive fluid hydration within 12 hr of transfer) was evaluated.
Setting:
Tertiary care, free-standing, academic children's hospital.
Patients:
All hospitalized acute care patients admitted over a 6-month time period (September 2012 to March 2013).
Interventions:
None.
Measurements And Main Results:
During the study time period, 33,800 patient-days and 136 deteriorations were evaluated. Area under the curve ranged from 0.88 (surgical) to 0.94 (cardiac). Sensitivities for a Pediatric Early Warning Score greater than or equal to 3 ranged from 75% (surgical) to 94% (cardiology) and number needed to evaluate to find one deterioration was 11.5 (neurologic) to 43 patients (surgical). Sensitivities for a Pediatric Early Warning Score greater than or equal to 4 ranged from 54% (general medical) to 79% (hematology/oncology/bone marrow transplant) and number needed to evaluate of 5.5 (neurologic) to 12 patients (general medical). Sensitivities for a Pediatric Early Warning Score of greater than or equal to 5 ranged from 25% (surgical) to 58% (hematology/oncology/bone marrow transplant) and number needed to evaluate of 3.5 (cardiac, hematology/oncology/bone marrow transplant, neurologic) to eight patients (surgical).
Conclusions:
An elevated Pediatric Early Warning Score is associated with ICU transfer and receipt of ICU-specific interventions in patients across different pediatric subspecialty patient populations.
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