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An Audit of a Modified Pediatric Early Warning Scoring System in a Tertiary Pediatric Hospital
Angela Hui Ping Kirk1, Yee Hui Mok2,3, Rehena Sultana4
1Nursing Clinical Service, Division of Nursing, KK Women's and Children's Hospital, Singapore.
Insights
The KK hospital early warning score (KEWS) effectively identifies pediatric patients needing transfer from general wards to higher care units. This score helps distinguish deteriorating children requiring intensive care from those who do not.
Area of Science:
- Pediatric critical care medicine
- Clinical informatics
- Patient safety systems
Background:
- Pediatric early warning systems are crucial for detecting patient deterioration.
- Effective systems are needed to identify children requiring transfer to high dependency units (HDU) or pediatric intensive care units (PICU).
Purpose of the Study:
- To evaluate the efficacy of a locally adapted pediatric early warning system, the KK hospital early warning score (KEWS).
- To determine if KEWS can accurately differentiate between pediatric patients who require transfer from general ward to HDU/PICU and those who do not.
Main Methods:
- A retrospective case-control study was conducted.
- Data included unplanned general ward to PICU/HDU transfers over one year.
- KEWS scores were collected at the time of transfer and up to 6 hours prior.
Main Results:
- The study included 196 cases and 588 controls.
- KEWS scores were significantly higher in patients requiring transfer (median 3 vs 0, P <.001).
- KEWS demonstrated strong discriminatory ability (AUC = 0.80) and predicted transfer with an odds ratio of 2.34 (P <.001) after adjustment.
Conclusions:
- The KK hospital early warning score (KEWS) is a reliable tool for identifying pediatric patients at risk of deterioration.
- KEWS can effectively distinguish children who need transfer from general ward to HDU/PICU from those who do not.
Objective:
Pediatric early warning systems identify patients at risk for deterioration. We aimed to determine if a locally adapted pediatric early warning system [KK hospital early warning score (KEWS)] can distinguish patients who require transfer from general ward to high dependency unit (HDU) or PICU, from those who do not.
Methods:
We conducted a retrospective case-control single-center audit. All unplanned general ward to PICU/HDU transfer from January to December 2021 were included as cases. We collected KEWS at the time of transfer and at 2, 4 and 6 hours prior to transfer. Univariate and multivariable logistic regression with imputation analysis were performed to identify variables associated with unplanned PICU/HDU transfer.
Results:
There were 784 patients (196 cases and 588 controls). Median age of cases and controls were 3.3 (interquartile range: 1.0-9.7) and 3.9 (0.8-11.3) years, respectively. At the time of transfer, median (interquartile range) KEWS for cases and controls were 3 (0, 4) and 0 (0, 1), respectively (P <.001). At all timepoints, KEWS was able to distinguish between children who did and did not require transfer to HDU/PICU (At time of transfer: area under the curve = 0.80, 95% CI = 0.75-0.85, P <.001). After adjusting for age, category of admission, frequency of ordered monitoring, KEWS predicted HDU/PICU transfer with an odds ratio of 2.34 (95% CI 1.82 to 3.00, P <.001).
Conclusions:
KEWS was able to distinguish patients requiring transfer from GW to HDU/PICU from those not needing a transfer.
