Related Experiment Video
Updated: Jul 16, 2025
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Evaluation of a modified paediatric early warning score for children with congenital heart disease
Simone Commotio1, Nicolas Leister1, Christoph Menzel1
1Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Germany.
Insights
A modified paediatric early warning score effectively identifies clinical deterioration in children with cyanotic congenital heart disease (CHD). This revised system offers improved sensitivity and specificity compared to the original score for this vulnerable population.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Clinical Monitoring Systems
Background:
- Paediatric early warning scores (PEWS) are crucial for detecting clinical deterioration in hospitalized children.
- Existing PEWS often perform poorly in children with cyanotic congenital heart disease (CHD) due to their adaptation to lower arterial oxygen saturation levels.
Purpose of the Study:
- To compare the efficacy of the original Paediatric European Working Party on Critical Care (PEWSS) score with a modified version tailored for children with cyanotic CHD.
Main Methods:
- A retrospective, single-center study was conducted in a pediatric cardiology intermediate care unit.
- The study analyzed the performance of both the original and modified PEWSS in identifying clinical deterioration.
Main Results:
- The original PEWSS showed a significant shift towards higher scores in cyanotic CHD patients, indicating potential unsuitability.
- The modified PEWSS demonstrated superior performance in identifying the need for clinical action in cyanotic CHD patients, with higher sensitivity and specificity compared to the original score.
- Receiver operating characteristic analysis showed improved area under the curve for the modified score in cyanotic CHD patients (0.862 vs. 0.731).
Conclusions:
- The modified PEWSS provides a uniform and effective scoring system for identifying clinical deterioration in both cyanotic and non-cyanotic pediatric patients.
- This modification enhances the reliability of PEWS for children with cyanotic CHD, improving patient safety and clinical management.
Background:
Paediatric early warning score systems are used for early detection of clinical deterioration of patients in paediatric wards. Several paediatric early warning scores have been developed, but most of them are not suitable for children with cyanotic CHD who are adapted to lower arterial oxygen saturation.
Aim:
The present study compared the original paediatric early warning system of the Royal College of Physicians of Ireland with a modification for children with cyanotic CHD.
Design:
Retrospective single-centre study in a paediatric cardiology intermediate care unit at a German university hospital.
Results:
The distribution of recorded values showed a significant shift towards higher score values in patients with cyanotic CHD (p < 0.001) using the original score, but not with the modification. An analysis of sensitivity and specificity for the factor "requirement of action" showed an area under the receiver operating characteristic for non-cyanotic patients of 0.908 (95% CI 0.862-0.954). For patients with cyanotic CHD, using the original score, the area under the receiver operating characteristic was reduced to 0.731 (95% CI 0.637-0.824, p = 0.001) compared to 0.862 (95% CI 0.809-0.915, p = 0.207), when the modified score was used. Using the critical threshold of scores ≥ 4 in patients with cyanotic CHD, sensitivity and specificity for the modified score was higher than for the original (sensitivity 78.8 versus 72.7%, specificity 78.2 versus 58.4%).
Conclusion:
The modified score is a uniform scoring system for identifying clinical deterioration, which can be used in children with and without cyanotic CHD.
Related Concept Videos
01:17Assessment of apical pulse
Assessing the apical pulse is a critical nursing procedure, particularly indicated for:
01:30Heart Failure IV: Classification and Diagnostic Evaluation