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Correlation of Bedside Pediatric Early Warning System Score to Interventions During Peritransport Period
Christopher K Page-Goertz1,2, Mahua Dasgupta3, Raymond G Hoffmann3
1Division of Critical Care Medicine, Akron Children's Hospital, Akron, OH.
Insights
The Bedside Pediatric Early Warning System score effectively predicts the need for interventions and patient disposition during interfacility transport. Higher scores indicate greater illness severity and a higher likelihood of intensive care unit transfer.
Area of Science:
- Pediatric critical care medicine
- Transport medicine
- Health informatics
Background:
- The Bedside Pediatric Early Warning System (BEWS) score is a validated tool for assessing illness severity in acute care inpatient settings.
- Its utility as a remote assessment tool for interfacility transport has not been previously evaluated.
- This study investigated the association between BEWS scores and peritransport interventions and patient disposition.
Purpose of the Study:
- To evaluate the Bedside Pediatric Early Warning System score as a remote assessment tool for interfacility transport.
- To determine if BEWS scores correlate with the need for interventions during transport.
- To assess the relationship between BEWS scores and patient disposition after transport.
Main Methods:
- A retrospective evaluation of children transported by a regional pediatric team over a 6-month period.
- BEWS scores were calculated at triage, transport team arrival, and transfer of care.
- Primary outcome was receipt of significant intervention; secondary outcomes included destination (ICU, ward, ED).
Main Results:
- Of 564 transported children, 139 (25%) received interventions, and 205 (36%) were admitted to the PICU.
- Children receiving interventions had significantly higher BEWS scores (median 8) compared to those without (median 2; p < 0.001).
- PICU admissions were associated with higher BEWS scores (median 6) compared to ward (median 3) or ED (median 2) dispositions (p < 0.001).
Conclusions:
- The Bedside Pediatric Early Warning System score at initial referral is a valuable indicator of illness severity during interfacility transport.
- BEWS scores accurately predict the need for significant peritransport interventions.
- BEWS scores correlate with patient disposition, with higher scores indicating a need for higher levels of care.
Background:
The Bedside Pediatric Early Warning System score is a validated measure of severity of illness in acute care inpatient settings. Its potential as a remote assessment tool for interfacility transport has not been evaluated. We hypothesized that the Bedside Pediatric Early Warning System score was associated with need for intervention during the peritransport period and patient disposition.
Methods:
We retrospectively evaluated children transported by a regional pediatric team during a 6-month period. Bedside Pediatric Early Warning System scores were calculated at the triage phone call, the transport team arrival, and at transfer of care to the hospital team. The primary outcome was the receipt of significant intervention during the peritransport period, with additional outcomes of destination (ICU, ward, emergency department) in the regional hospital. Scores are presented as median values (interquartile range).
Results:
There were 564 children who underwent transport; 139 (25%) received interventions; and 205 (36%) were transferred to the PICU, 231 (41%) to the ward, and 127 (23%) to the emergency department. Scores were 2 (1-5; median interquartile range) in children receiving no in-transport interventions, 8 (5-11) in children receiving any intervention (p < 0.001), and 10 (7-14) in children receiving more than one intervention. Children transferred to the PICU had higher scores 6 (3-10), than children transferred to a ward 3 (1-6) or the emergency department 2 (1-3) (p < 0.001).
Conclusions:
The Bedside Pediatric Early Warning System score at the time of initial referral is a useful measure of severity of illness reflected by the subsequent provision of significant peritransport intervention and the transfer destination.
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