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Published on: January 26, 2019
A retrospective evaluation of SwePEWS use in paediatric patients with COVID-19 and RSV infection
Julia Bodlund1, Albin Wimmerdahl1, Antoine Honoré1
1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Insights
The Swedish Paediatric Early Warning Score (SwePEWS) has significant errors and underestimates patient deterioration, showing low accuracy in predicting intensive care unit transfers. This highlights challenges in implementing pediatric early warning scores.
Area of Science:
- Pediatric critical care medicine
- Clinical informatics
- Patient safety
Background:
- Early detection of clinical deterioration in children is crucial but challenging.
- The Swedish Paediatric Early Warning Score (SwePEWS) is a tool for systematic patient assessment.
- Evaluating the real-world application and predictive accuracy of SwePEWS is essential.
Purpose of the Study:
- To evaluate the utilization and predictive performance of the Swedish Paediatric Early Warning Score (SwePEWS).
- To identify discrepancies between registered vital signs and assigned SwePEWS scores.
- To assess SwePEWS's ability to predict transfer to the pediatric intensive care unit (PICU).
Main Methods:
- Retrospective review of electronic health records for pediatric patients with RSV or COVID-19.
- Comparison of registered vital signs against assigned SwePEWS scores and continuous monitoring data.
- Analysis of SwePEWS's predictive accuracy for PICU transfer.
Main Results:
- One-third of 1374 SwePEWS assessments contained errors or were incomplete, particularly during night shifts.
- Single oxygen saturation measurements were lower than continuous monitoring averages.
- The Swedish Paediatric Early Warning Score (SwePEWS) demonstrated low predictive ability for PICU transfer.
Conclusions:
- A high incidence of underestimated SwePEWS scores was observed, indicating potential patient risk misjudgment.
- The study identifies critical pitfalls in the development and implementation of pediatric early warning scores.
- Systematic re-evaluation of pediatric early warning score protocols is recommended to improve patient safety.
Aim:
As early detection of deterioration is a challenge in children, the Swedish Paediatric Early Warning Score (SwePEWS) is used to systematically assess paediatric patients' clinical state. Here, we aimed to evaluate the use and predictive ability of SwePEWS.
Methods:
Electronic health records of paediatric patients admitted due to respiratory syncytial virus infection or COVID-19 were reviewed retrospectively. Registered vital signs were compared to the assigned SwePEWS score and monitored vital sign values to identify discrepancies. Additionally, SwePEWS's ability to predict transfer to the paediatric intensive care unit (PICU) was assessed.
Results:
Among 1374 SwePEWS assessments, one-third were either incomplete or contained errors. Incomplete SwePEWS assessments were more frequent during night-time. Single measurements of oxygen saturation presented lower values compared to average saturation from continuous monitoring. SwePEWS's ability to predict PICU transfer was low.
Conclusion:
There was a surprisingly high occurrence of underestimated SwePEWS scores. This study provides new insights into pitfalls when developing and implementing paediatric early warning scores for systematic re-evaluations in paediatric patients.
