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Performance of a Pediatric Early Warning Score Among Children With Severe Acute Malnutrition
Christopher T Andersen1,2, Susan M Rattigan3, Céline Langendorf4
1Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Insights
A new Pediatric Early Warning System (PEWS) effectively identified children with severe acute malnutrition (SAM) at high risk of death. This tool aids in predicting adverse outcomes for better inpatient care in resource-limited settings.
Area of Science:
- Pediatric critical care
- Global child health
- Malnutrition research
Background:
- Pediatric Early Warning Systems (PEWSs) are crucial for predicting adverse outcomes in hospitalized children.
- Evidence for PEWS performance in resource-limited settings, particularly for severe acute malnutrition (SAM), is limited.
- A novel Médecins Sans Frontières (MSF)-PEWS was developed to address this gap.
Purpose of the Study:
- To evaluate the effectiveness of a novel MSF-PEWS score in predicting adverse clinical outcomes, including mortality, in children with complicated SAM.
- To assess the association between PEWS color categories at admission and during hospitalization with clinical deterioration and mortality.
- To determine the utility of the MSF-PEWS in a resource-limited setting in Niger.
Main Methods:
- A longitudinal study followed 4215 children hospitalized with SAM in Madarounfa, Niger.
- A novel MSF-PEWS, using 9 clinical indicators summarized into color categories (green, orange, yellow, red), was assessed regularly.
- Associations between admission and time-varying PEWS color categories with clinical deterioration, mortality, and length of stay were analyzed.
Main Results:
- Children in the red MSF-PEWS category at admission had a 2.58 times greater risk of death compared to the green category.
- In time-varying analyses, children in the red category were 11.9 times more likely to die within 48 hours than those in the green category.
- More severe PEWS color categories correlated with longer hospital stays and shorter time to death.
Conclusions:
- The MSF-PEWS demonstrated effectiveness in identifying children with complicated SAM at high risk of adverse outcomes, including mortality.
- The findings support the use of this novel PEWS tool for improved inpatient management of SAM in resource-limited environments.
- The MSF-PEWS can aid clinicians in timely intervention and resource allocation for critically ill children with malnutrition.
Objectives:
Pediatric Early Warning Systems (PEWSs) have been used to predict adverse outcomes among hospitalized patients, though evidence is limited in resource-limited settings. We aimed to assess the performance of a novel PEWS score in a population of children with complicated severe acute malnutrition (SAM).
Methods:
Children hospitalized with SAM in Madarounfa, Niger were followed longitudinally from hospital admission to discharge. A novel Médecins Sans Frontières (MSF)-PEWS used scores for 9 clinical indicators, summarized into color categories (in increasing order of severity: green, orange, yellow, red) and assessed regularly throughout hospitalization. We estimated the association of color category at admission with subsequent clinical deterioration and mortality, as well as the association between time-varying color category with mortality within 48 hours and time to discharge or death.
Results:
In total, 4215 children were included in the analysis. Children in the red MSF-PEWS color category at admission had 2.58 (95% CI, 1.87-3.55) times greater risk of death during treatment compared with children in the green category at admission. In time-varying analyses, children classified in the red category at any given time were 11.9 (95% CI, 11.3-12.6) times more likely to die in the following 48 hours than children in the green category. More severe color categories were associated with longer lengths of hospital stay and shorter times until death.
Conclusions:
MSF-PEWS scores were effective at identifying children at higher risk of adverse clinical outcomes, including mortality, during inpatient treatment for complicated SAM in Niger.
