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Validation of the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in low- and middle-income
Naomi Kemps1, Natanael Holband2, Navin P Boeddha1,2
1Department of General Paediatrics, Erasmus MC- Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Insights
The Emergency Department-Paediatric Early Warning Score (ED-PEWS) shows moderate to good performance in identifying critically ill children in low- and middle-income countries (LMICs). This validated tool can help improve early recognition of serious illness in these settings.
Area of Science:
- Pediatric Emergency Medicine
- Global Health
- Clinical Assessment Tools
Background:
- Early recognition of serious illness in children is crucial for reducing morbidity and mortality, especially in low- and middle-income countries (LMICs).
- Existing early warning scores may not be suitable for acute care settings in LMICs.
- The Emergency Department-Paediatric Early Warning Score (ED-PEWS) is a tool designed for rapid assessment.
Purpose of the Study:
- To validate the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in diverse acute care settings within LMICs.
- To assess the performance of ED-PEWS in identifying children requiring urgent care in these resource-limited environments.
Main Methods:
- An observational study utilizing previously collected clinical data from four LMIC settings (Gambia rural, Gambia urban, Suriname, Tanzania) between 2010-2021.
- Simulation of the ED-PEWS using parameters such as age, consciousness, respiratory rate, and oxygen saturation.
- Assessment of discrimination using area under the curve (AUC), sensitivity, and specificity, with a composite marker for high urgency as the outcome.
Main Results:
- Data from 41,917 visits (Gambia rural), 501 (Gambia urban), 2,608 (Suriname), and 1,682 (Tanzania) were analyzed.
- The proportion of high-urgency cases varied significantly across settings (4.6% to 24.9%).
- ED-PEWS demonstrated moderate to good performance, with AUCs ranging from 0.62 to 0.80, high sensitivity for low-urgency cut-offs (0.83-1.00), and variable specificity for high-urgency cut-offs (0.71-0.97).
Conclusions:
- The ED-PEWS shows potential for improving the identification of high-urgency children in LMIC settings.
- The score exhibits moderate to good performance, suggesting its utility in resource-limited acute care environments.
- Further implementation and validation studies are warranted to optimize its use in global pediatric emergency care.
Abstract:
Early recognition of children at risk of serious illness is essential in preventing morbidity and mortality, particularly in low- and middle-income countries (LMICs). This study aimed to validate the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in acute care settings in LMICs. This observational study is based on previously collected clinical data from consecutive children attending four diverse settings in LMICs. Inclusion criteria and study periods (2010-2021) varied. We simulated the ED-PEWS, consisting of patient age, consciousness, work of breathing, respiratory rate, oxygen saturation, heart rate, and capillary refill time, based on the first available parameters. Discrimination was assessed by the area under the curve (AUC), sensitivity and specificity (previously defined cut-offs < 6 and ≥ 15). The outcome measure was for each setting a composite marker of high urgency. 41,917 visits from Gambia rural, 501 visits from Gambia urban, 2,608 visits from Suriname, and 1,682 visits from Tanzania were included. The proportion of high urgency was variable (range 4.6% to 24.9%). Performance ranged from AUC 0.80 (95%CI 0.70-0.89) in Gambia urban to 0.62 (95%CI 0.55-0.67) in Tanzania. The low-urgency cut-off showed a high sensitivity in all settings ranging from 0.83 (95%CI 0.81-0.84) to 1.00 (95%CI 0.97-1.00). The high-urgency cut-off showed a specificity ranging from 0.71 (95%CI 0.66-0.75) to 0.97 (95%CI 0.97-0.97). The ED-PEWS has a moderate to good performance for the recognition of high urgency children in these LMIC settings. The performance appears to have potential in improving the identification of high urgency children in LMICs.
