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Comparing Two Proximal Measures of Unrecognized Clinical Deterioration in Children
Tina Sosa1, Sarah Ferris1, Carol Frese2
1Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Critical deterioration events (CDEs) and emergency transfers (ETs) in children often stem from respiratory issues. While systems like watcher identification and pediatric early warning scores (PEWS) show promise, improved escalation plans are needed for high-risk patients.
Area of Science:
- Pediatric critical care
- Clinical deterioration
- Patient safety systems
Background:
- Critical deterioration events (CDEs) and emergency transfers (ETs) are key indicators of clinical deterioration in children.
- These events aim to assess the recognition and response systems for deteriorating pediatric patients.
Purpose of the Study:
- To characterize CDEs and ETs by timing, overlap, and intervention category.
- To evaluate the performance of watcher identification systems and pediatric early warning scores (PEWS) in identifying patients experiencing these events.
Main Methods:
- Retrospective observational study.
- Analysis of 359 CDEs and 88 ETs.
- Evaluation of watcher identification and PEWS performance.
Main Results:
- Respiratory events were the most frequent cause (80.5% of CDEs, 47.7% of ETs).
- Watchers identified a majority of patients (55.4% CDEs, 51.1% ETs).
- Combined identification (watchers/elevated PEWS) captured 85.5% of CDEs and 87.5% of ETs.
Conclusions:
- Existing systems show some effectiveness in identifying at-risk pediatric patients.
- Opportunities exist to enhance escalation plans for high-risk patients to prevent emergent interventions.
Abstract:
Critical deterioration events (CDEs) and emergency transfers (ETs) are two proximal measures to cardiopulmonary arrest, and both aim to evaluate how systems recognize and respond to clinical deterioration in children. This retrospective observational study sought to (1) characterize CDEs and ETs by timing, overlap, and intervention category, and (2) evaluate the performance of the watcher identification system and the pediatric early warning score (PEWS) to identify patients who experience these events. A total of 359 CDEs and 88 ETs occurred during the study period. Respiratory events were most common and accounted for 80.5% of CDEs and 47.7% of ETs. A narrow majority of patients were identified as watchers (55.4% of CDEs and 51.1% of ETs). In total, 85.5% of CDEs and 87.5% of ETs were identified as watchers, elevated PEWS, or both. Opportunities exist for improved escalation plans for high-risk patients to prevent the need for emergent intervention.
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