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Provisional Validation of a Pediatric Early Warning Score for Resource-Limited Settings

Samantha L Rosman1, Valens Karangwa2, Michael Law3,4

  • 1Divisions of Pediatric Emergency Medicine and samantha.rosman@childrens.harvard.edu.

Pediatrics
|April 18, 2019
PubMed

Insights

The Pediatric Early Warning Score for Resource-Limited Settings (PEWS-RL) effectively identifies children at risk of deterioration in resource-limited areas. This simple score, based on vital signs, is feasible and accurate for early detection.

Area of Science:

  • Pediatric critical care
  • Global health equity
  • Clinical score development

Background:

  • Pediatric Early Warning Scores (PEWS) are increasingly used for early detection of patient deterioration.
  • The efficacy of existing PEWS in resource-limited settings remains unestablished.
  • Rapid response to deteriorating pediatric patients is crucial in all healthcare environments.

Purpose of the Study:

  • To develop and validate a Pediatric Early Warning Score specifically for resource-limited settings (PEWS-RL).
  • To assess the feasibility and accuracy of PEWS-RL in identifying children at high risk of clinical deterioration.
  • To establish the utility of PEWS-RL in a low-resource hospital environment.

Main Methods:

  • Developed the PEWS-RL using expert opinion and existing scores, comprising 6 equally weighted variables.
  • Conducted a case-control study in Kigali, Rwanda, comparing children with clinical deterioration (cases) to matched controls.
  • Collected data from 79 case patients and 79 controls admitted to the pediatrics department.

Main Results:

  • A PEWS-RL score of ≥3 demonstrated high sensitivity (96.2%) and specificity (87.3%) for identifying clinical deterioration.
  • A PEWS-RL score of ≥3 was significantly associated with an increased risk of deterioration (OR 129.3, P <.005).
  • The PEWS-RL was feasible to implement in the study setting.

Conclusions:

  • The PEWS-RL is a feasible and effective tool for identifying children at risk of clinical deterioration in resource-limited settings.
  • The score, based on vital signs, mental status, and respiratory distress, aids in early intervention.
  • PEWS-RL can improve pediatric patient outcomes in areas with limited resources.
Abstract

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