Recognizing critically ill children with a modified pediatric early warning score at the emergency department, a feasibility study
Pediatric Early Warning Scores were developed to monitor clinical deterioration of children admitted to the hospital. Pediatric Early Warning Scores could also be useful in the Emergency Department to quickly identify critically ill patients so treatment can be started without delay. To determine if a newly designed, fast, and easy to use Modified Pediatric Early Warning Score can identify critically ill children in the Emergency Department. We conducted a retrospective observational study in the Emergency Department of an urban district hospital in Rotterdam, the Netherlands. Patients < 16 years attending the Emergency Department with an internal medical problem were included. Immediate intensive care unit admission was used as a measure for critically ill children. During the study period 2980 children attended the Emergency Department, ten (0.4%) of them required immediate intensive care unit admission. The Modified Pediatric Early Warning Score can identify critically ill children in the general pediatric Emergency Department population (area under the ROC curve 0.82). A sensitivity of 80% and specificity of 85% show potential to rule out critical illness in children visiting the Emergency Department when these results are validated in a larger population. A model containing both the Modified Pediatric Early Warning Score and the Manchester Triage System did not perform significantly better than the Manchester Triage System alone but did show a positive tendency in favor of the model containing the Modified Pediatric Early Warning Score and Manchester Triage System, area under the ROC curve 0.89 [95% CI 0.77–1.00] versus area under the ROC curve 0.82 [95% CI 0.68–0.95].
What is known:
• Pediatric Early Warning Scores can identify children who are in need for immediate intensive care unit admission at the Emergency Department.
• Pediatric Early Warning Scores can be time-consuming, contain subjective parameters or parameters which are difficult to obtain in a reliable and standardized method.
What is new:
• We introduce a simplified, manageable and smartly designed Pediatric Early Warning Score on a pocket card based on an existing and previously investigated Pediatric Early Warning Score.
• In this feasibility study the diagnostic performance of the Modified Pediatric Early Warning Score to predict immediate intensive care unit admission in the Emergency Department is in line with the original Pediatric Early Warning Scores but has to be validated on a larger scale.
KeywordsPediatric early warning scores Triage Emergency department Referral and consultation Intensive care
Intensive care unit
Manchester Triage System
Pediatric Early Warning Score
Modified Pediatric Early Warning Score
Receiver operating curve
We would like to thank the Maasstad Academy in person of Martijn Kuijper, statistician and epidemiologist, for providing suggestions in the manuscript review process.
S.J. Vredebregt has conceptualized and designed this study, carried out the analyses, and drafted the manuscript.
H.A. Moll has designed the initial study, supervised analyses, and reviewed and revised the manuscript.
F.J. Smit has supervised the data collection and reviewed and revised the manuscript.
J.J. Verhoeven has conceptualized and designed the study, designed the Modified Pediatric Early Warning Score, and reviewed and revised the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest
No relevant relationships to this article
This study was approved by the medical ethical committee of the Maasstad Hospital as part of a larger study, the requirement for informed consent was waived.
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