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Recognizing critically ill children with a modified pediatric early warning score at the emergency department, a feasibility study

European Journal of Pediatrics volume 178, pages 229–234 (2019)Cite this article

Abstract

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].

Conclusions: In this feasibility study, the Modified Pediatric Early Warning Score could be a fast and easy to use tool to identify critically ill children in the general pediatric Emergency Department population. The effectiveness of the Modified Pediatric Early Warning Score may be optimized if combined with triage systems such as the Manchester Triage System. A larger prospective study is needed to confirm our results.

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.

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Abbreviations

ED:

Emergency Department

ICU:

Intensive care unit

MTS:

Manchester Triage System

PEWS:

Pediatric Early Warning Score

MPEWS:

Modified Pediatric Early Warning Score

ROC:

Receiver operating curve

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Acknowledgments

We would like to thank the Maasstad Academy in person of Martijn Kuijper, statistician and epidemiologist, for providing suggestions in the manuscript review process.

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Affiliations

  1. Department of Pediatrics, Maasstad Hospital, Room 1F2042, PO box 9100, 3007 AC, Rotterdam, The Netherlands

    S. J. Vredebregt, F. J. Smit & J. J. Verhoeven

  2. Department of Pediatrics, Erasmus MC-Sophia Children’s Hospital, dr. Molenwaterplein 60, 3015 GJ, Rotterdam, The Netherlands

    H. A. Moll

Authors
  1. S. J. Vredebregt
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  2. H. A. Moll
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  3. F. J. Smit
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  4. J. J. Verhoeven
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Contributions

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.

Corresponding author

Correspondence to J. J. Verhoeven.

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The authors declare that they have no conflict of interest

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No relevant relationships to this article

Informed consent

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.

Additional information

Communicated by Mario Bianchetti

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Vredebregt, S.J., Moll, H.A., Smit, F.J. et al. Recognizing critically ill children with a modified pediatric early warning score at the emergency department, a feasibility study. Eur J Pediatr 178, 229–234 (2019). https://doi.org/10.1007/s00431-018-3285-9

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  • DOI: https://doi.org/10.1007/s00431-018-3285-9

Keywords

  • Pediatric early warning scores
  • Triage
  • Emergency department
  • Referral and consultation
  • Intensive care