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Validation of a Paediatric Early Warning Score: first results and implications of usage

European Journal of Pediatrics volume 174, pages 15–21 (2015)Cite this article

Abstract

Timely recognition of deterioration of hospitalised children is important to improve mortality. We developed a modified Paediatric Early Warning Score (PEWS) and studied the effects by performing three different cohort studies using different end points. Taking unplanned Paediatric Intensive Care Unit admission as end point and only using data until 2 h prior to end point, we found a sensitivity of 0.67 and specificity of 0.88 to timely recognise patients. This proves that earlier identification is possible without a loss of sensitivity compared to other PEWS systems. When determining the corresponding clinical condition in patients with an elevated PEWS dichotomously as ‘sick’ or ‘well’, this resulted in a total of 27 % false-positive scores. This can cause motivational problems for caregivers to use the system but is a consequence of PEWS design to minimise false-negative rates because of high mortality associated with paediatric resuscitation. Using the need for emergency medical interventions as end point, sensitivity of PEWS is high and it seems, therefore, that it is also fit to alert health-care professionals that urgent interventions may be needed. Conclusion: These data show the effectiveness of a modified PEWS in identifying critically ill patients in an early phase making early interventions possible and hopefully reduce mortality.

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Fig. 1

Abbreviations

PEWS:

Paediatric Early Warning Score

PICU:

Paediatric Intensive Care Unit

SA:

Situational awareness

SSE:

Serious safety event

References

  1. Akre M, Finkelstein M, Erickson M, Liu M, Vanderbilt L et al (2010) Sensitivity of the Pediatric Early Warning Score to identify patient deterioration. Pediatrics 125:e763–e769

    Article  PubMed  Google Scholar 

  2. Bleetman A, Sanusi S, Dale T, Brace S (2012) Human factors and error prevention in emergency medicine. Emerg Med J 29(5):389–393

    Article  PubMed  Google Scholar 

  3. Bonafide CP, Roberts KE, Weirich CM, Paciotti B, Tibbetts KM, Keren R, Barg FK, Holmes JH (2013) Beyond statistical prediction: qualitative evaluation of the mechanisms by which pediatric early warning scores impact patient safety. J Hosp Med 8(5):248–253

    Article  PubMed  Google Scholar 

  4. Burch VC, Tarr G, Morroni C (2008) Modified early warning score predicts the need for hospital admission and inhospital mortality. Emerg Med J 25(10):674–678

    Article  CAS  PubMed  Google Scholar 

  5. Cooksley T, Kitlowski E, Haji-Michael P (2012) Effectiveness of Modified Early Warning Score in predicting outcomes in oncology patients. QJM 105(11):1083–1088

    Article  PubMed  Google Scholar 

  6. Edwards ED, Powell CV, Mason BW, Oliver A (2009) Prospective cohort study to test the predictability of the Cardiff and Yale paediatric early warning system. Arch Dis Child 94(8):602–606

    Article  CAS  PubMed  Google Scholar 

  7. Girotra S, Spertus JA, Li Y, Berg RA, Nadkarni VM, Chan PS (2013) Survival trends in pediatric in-hospital cardiac arrests: an analysis from Get With the Guidelines-Resuscitation. Circ Cardiovasc Qual Outcomes 6(1):42–49

    Article  PubMed Central  PubMed  Google Scholar 

  8. Isaacman DJ, Shults J, Gross TK, Davis PH, Harper M (2000) Predictors of bacteremia in febrile children 3 to 36 months of age. Pediatrics 106(5):977–982

    Article  CAS  PubMed  Google Scholar 

  9. McCabe A, Duncan H, Heward Y (2009) Paediatric early warning systems: where do we go from here? Paediatr Nurs 21(1):14–17

    Article  PubMed  Google Scholar 

  10. McGaughey J, Alderdice F, Fowler R, Kapila A, Mayhew A, Moutray M (2007) Outreach and Early Warning Systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards. Cochrane Database Syst Rev 3, CD005529

    PubMed  Google Scholar 

  11. Parshuram CS, Duncan HP, Joffe AR, Farrell CA, Lacroix JR, Middaugh KL, Hutchison JS, Wensley D, Blanchard N, Beyene J, Parkin PC (2011) Multicentre validation of the bedside paediatric early warning system score: a severity of illness score to detect evolving critical illness in hospitalized children. Crit Care 15(4):R184

    Article  PubMed Central  PubMed  Google Scholar 

  12. Roland D (2012) Paediatric early warning scores: Holy Grail and Achilles’ heel. Arch Dis Child Educ Pract Ed 97(6):208–215

    Article  PubMed  Google Scholar 

  13. Solevåg AL, Eggen EH, Schröder J, Nakstad B (2013) Use of a modified pediatric early warning score in a department of pediatric and adolescent medicine. PLoS One 8(8):e72534

    Article  PubMed Central  PubMed  Google Scholar 

  14. Subbe CP, Kruger M, Rutherford P, Gemmel L (2001) Validation of a modified Early Warning Score in medical admissions. QJM 94(10):521–526

    Article  CAS  PubMed  Google Scholar 

  15. Tucker KM, Brewer TL, Baker RB, Demeritt B, Vossmeyer MT (2009) Prospective evaluation of a pediatric inpatient early warning scoring system. Spec Pediatr Nurs 14(2):79–85

    Article  Google Scholar 

  16. Van den Bruel A, Haj-Hassan T, Thompson M, Buntinx F, Mant D, European Research Network on Recognising Serious Infection investigators (2010) Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries: a systematic review. Lancet 375(9717):834–845

    Article  PubMed  Google Scholar 

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Conflict of interest

No conflict of interest is to be reported.

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Authors and Affiliations

  1. Department of Paediatrics, Radboudumc Amalia Children’s Hospital, PO box 9101, 6500 HB, Nijmegen, The Netherlands

    Joris Fuijkschot, Bastiaan Vernhout, Jos M. T. Draaisma & Jan L. C. M. Loeffen

  2. Department of Intensive Care, Radboudumc Amalia Children’s Hospital, PO box 9101, 6500 HB, Nijmegen, The Netherlands

    Joris Lemson

  3. Institute for Warranted Quality and Patient Safety, Radboudumc Amalia Children’s Hospital, PO box 9101, 6500 HB, Nijmegen, The Netherlands

    Jan L. C. M. Loeffen

Authors
  1. Joris Fuijkschot
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  2. Bastiaan Vernhout
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  3. Joris Lemson
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  4. Jos M. T. Draaisma
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  5. Jan L. C. M. Loeffen
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Corresponding author

Correspondence to Joris Fuijkschot.

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Communicated by Patrick Van Reempts

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Fuijkschot, J., Vernhout, B., Lemson, J. et al. Validation of a Paediatric Early Warning Score: first results and implications of usage. Eur J Pediatr 174, 15–21 (2015). https://doi.org/10.1007/s00431-014-2357-8

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  • DOI: https://doi.org/10.1007/s00431-014-2357-8

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