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Evaluation of Pediatric Early Warning Score (PEWS) in Unintentional Childhood Injuries Admitted to the Critical Care
Sagar Malde1, Prajvi Jain1, Natesan Revathi1
1Pediatrics, Mahatma Gandhi Missions (MGM) Medical College, Navi Mumbai, IND.
Insights
The Pediatric Early Warning Score (PEWS) effectively predicts outcomes in critically ill children with unintentional injuries. This score can identify children at risk, guiding timely interventions for better patient management.
Area of Science:
- Pediatric critical care medicine
- Injury epidemiology
- Clinical risk assessment tools
Background:
- The Pediatric Early Warning Score (PEWS) was developed to identify children at risk of clinical deterioration.
- This study focuses on unintentional injuries in children admitted to a critical care unit.
- Understanding the epidemiology and predictive factors for these injuries is crucial.
Purpose of the Study:
- To describe the epidemiology of unintentional injuries in pediatric critical care admissions.
- To evaluate the predictive capabilities of the Pediatric Early Warning Score (PEWS) for injury-related outcomes.
- To inform the development of targeted injury prevention strategies.
Main Methods:
- A cross-sectional study design was employed.
- Injury data were analyzed using Haddon's matrix (agent, host, environment).
- Pediatric Early Warning Score (PEWS) was assessed on admission; outcomes included ICU stay, interventions, and mortality.
Main Results:
- 157 children were analyzed; common injuries included bites (35.7%), falls (24.2%), and poisoning (21.7%).
- Most injuries occurred at home (52.7%) with a caretaker present (40.0%).
- PEWS classification showed high sensitivity (100%) and specificity (88.3%) for predicting death when categorized as red vs. others.
Conclusions:
- Unintentional childhood injuries frequently occur at home, highlighting the need for 'safe home interventions' and parental first-aid training.
- Baseline PEWS is a valuable predictor of both adverse and positive outcomes in pediatric injury cases.
- Regular implementation of PEWS in managing childhood injuries could improve patient outcomes.
Introduction:
Pediatric Early Warning Score (PEWS), also known as Brighton PEWS or Monaghan PEWS, was developed to identify children at risk for clinical deterioration in hospitals. We designed this study to describe the epidemiology of unintentional injuries in children admitted to the critical care unit in a tertiary healthcare setting, and to determine the predictive properties of PEWS in these injuries.
Methods:
This is a cross-sectional study. Injury-related data were based on Haddon's matrix of agent, host, and environment factors. Each child was evaluated using PEWS on admission. We noted the following outcomes: duration of stay in the intensive unit; major intervention required; and death.
Results:
We analyzed data from 157 children. Most of the children were in the age group of one to five years (57.7%), followed by more than five to 12 years old (37.6%). The most common injuries were bites (35.7%), falls (24.2%), and poisoning (21.7%). These injuries occurred at home (52.7%) and in the presence of a caretaker (40.0%). On admission, 11% of children were classified as green, 40% as yellow, 36% as orange, and 13% as red by PEWS. Classification of red versus the rest (orange/yellow/green) had a high sensitivity (100%), specificity (88.3%), and negative predictive value (100%) for "death" as an outcome.
Conclusion:
Most of the injuries occurred at home and at a time when the caretaker was around. Thus, it will be useful to develop "safe home interventions" and train parents in first aid to take care of these injuries on-site. Baseline PEWS was a good predictor of "poor" as well as "positive" outcomes. It may be worthwhile to implement this score regularly in the management of childhood injuries in hospitals.
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