Validity of Pediatric Early Warning Score in Predicting Unplanned Pediatric Intensive Care Unit Readmission

Area of Science:

• Pediatric critical care medicine
• Clinical risk assessment
• Healthcare quality improvement

Background:

• Unscheduled pediatric intensive care unit (PICU) readmissions carry significant negative consequences.
• Existing predictive tools for PICU readmission are often not suitable for clinical use.
• There is a critical need for a reliable tool to identify children at high risk of early readmission.

Purpose of the Study:

• To evaluate the efficacy of the modified Brighton pediatric early warning score (PEWS) in predicting unplanned PICU readmissions.
• To determine if PEWS can identify pediatric patients at high risk for readmission within 48 hours of discharge.
• To assess the association between PEWS scores at discharge and the likelihood of early readmission.

Main Methods:

• Retrospective cohort study including patients aged 1 month to 18 years discharged from two tertiary children's hospitals.
• Analysis of demographic data and the relationship between PEWS and early readmission (within 48 hours).
• Multivariable logistic regression was used to analyze the predictive value of PEWS.

Main Results:

• Out of 416 patients, 27 experienced early PICU readmission.
• Readmitted patients were significantly younger (≤12 months) and more likely to have been admitted from the emergency department.
• Higher PEWS scores at discharge were strongly associated with readmission (mean PEWS 3.07 vs. 0.8, p < 0.001).
• A PEWS cut-off of 2 demonstrated 85.2% sensitivity and 78.1% specificity for predicting readmission.
• Each 1-point increase in PEWS at discharge significantly elevated readmission risk (OR = 3.58, p < 0.001).

Conclusions:

• The modified Brighton pediatric early warning score (PEWS) is a valuable tool for predicting unscheduled PICU readmissions.
• A PEWS score of 2 or higher effectively identifies high-risk pediatric patients.
• Further large-scale research is warranted to confirm the clinical utility of PEWS in practice.