Risk stratification to improve Pediatric Early Warning Systems: it is all about the context

Area of Science:

• Pediatric critical care medicine
• Clinical risk stratification
• Patient safety systems

Background:

• Prompt recognition of clinical deterioration is crucial for reducing pediatric morbidity and mortality.
• Conventional Pediatric Early Warning Systems (PEWS) have demonstrated limitations in sensitivity and detection window.

Purpose of the Study:

• To develop and evaluate a novel risk stratification system, the Pediatric Risk Evaluation and Stratification System (PRESS).
• To compare the sensitivity of PRESS with conventional PEWS in identifying critically ill pediatric patients prior to adverse events.

Main Methods:

• A single-center retrospective cohort study involving pediatric intensive care unit (PICU) admissions.
• Inclusion criteria: infants to adolescents (<18 years) with unplanned PICU admission.
• Comparison of PRESS sensitivity against PEWS in detecting clinical deterioration within 24 hours prior to an endpoint.

Main Results:

• PRESS demonstrated significantly higher sensitivity (70%) compared to PEWS (30%) at 2 hours prior to endpoint (p < 0.001).
• Excluding seizure patients, PRESS sensitivity further improved to 75%.
• A majority of patients (66%) scored positive for at least one high-risk factor in the PRESS system.

Conclusions:

• Risk stratification using PRESS appears advantageous for earlier detection of clinical deterioration in pediatric patients.
• The PRESS system offers opportunities for timely intervention, potentially improving patient outcomes.
• Combining risk stratification with continuous monitoring may lead to next-generation warning systems for enhanced patient safety.