Comparison of Two Pediatric Early Warning Systems: A Randomized Trial

Area of Science:

• Pediatric critical care medicine
• Clinical informatics
• Patient safety systems

Background:

• Pediatric Early Warning Systems (PEWS) are crucial for detecting clinical deterioration in hospitalized children.
• Existing PEWS validation is limited, with variable performance reported in single-center studies.
• Multicenter validation is needed to compare PEWS efficacy.

Purpose of the Study:

• To compare the performance of two distinct PEWS: The Bedside PEWS and CDR PEWS.
• To evaluate their effectiveness in detecting clinical deterioration in hospitalized children across multiple centers.

Main Methods:

• A randomized, multicenter, unblinded trial involving 16,213 pediatric patients (31,337 admissions) across the Central Denmark Region.
• Patients were randomized to either The Bedside PEWS or CDR PEWS.
• The primary outcome measured was the rate of clinical deterioration requiring transfer to a higher level of care.

Main Results:

• No statistically significant difference was found between The Bedside PEWS (14 transfers) and CDR PEWS (8 transfers) in preventing unplanned transfers (P=0.20).
• Both systems demonstrated similar predictive capabilities for unplanned transfers (P=0.78).
• No significant differences were observed in secondary outcome measures.

Conclusions:

• The CDR PEWS is as effective as The Bedside PEWS in preventing critical events.
• CDR PEWS may offer improved staff acceptability, indicated by shorter reassessment times and fewer late reassessments.
• Further research is warranted to address the challenges in evaluating PEWS, especially given the low incidence of clinical deterioration observed.