Advertisement

The application of pediatric early warning score (PEWS) in emergency observation room

      Abstract

      Objective

      To explore the value of pediatric early warning scoring system (PEWS) in an emergency observation room in China.

      Methods

      The children who had been admitted consecutively to the emergency observation room from Jan, 2019 to Aug, 2020 were selected. Three most important time-points including the first value (admission value), the highest value during the observation (highest value), and final value (discharge value) of Brighton Pediatric Early Warning Score (PEWS) was evaluated in all patients.

      Results

      4717 patients were included. They were categorized into 3 groups, namely, discharged group (G1, n = 2320), specialized ward group (G2, n = 2128), and ICU group (G3, n = 269). The different PEWS values of admission value, highest value, and discharge value were significantly different among the 3 groups (P<0.001). Highest value of G1 and G2 were significantly lower than that of G3 (P<0.001). AUROC curves of different PEWS values were used to predict the possibility of PICU admission and PICU mortality within 24 h of admission, and the values were 0.698, 0.878, 0.974 and 0.709, 0.883, 0.951, respectively. The cutoff values for PICU admission of 3 different PEWS values were 2.5 (sensitivity 0.635, specificity 0.699), 3.5 (sensitivity 0.817, specificity 0.9), 3.5 (sensitivity 0.837, specificity 0.985). The cutoff values for PICU mortality of 3 different PEWS values were 4 (sensitivity 0.625, specificity 0.799), 4.5 (sensitivity 0.722, specificity 0.79), 4.5 (sensitivity 0.883, specificity 0.987). The discharge value had the strongest prediction ability.

      Conclusions

      PEWS can be used for early identification and warning of critically ill children.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      References

        • Adam S.
        • Odell M.
        An acute problem? A report of the national confidential enquiry into patient outcome and death.
        Nursing in Critical Care. 2005; 10: 225-227
        • Bleyer A.J.
        • Vidya S.
        • Russell G.B.
        • Jones C.M.
        • Sujata L.
        • Daeihagh P.
        • Hire D.
        Longitudinal analysis of one million vital signs in patients in an academic medical center.
        Resuscitation. 2011; 82: 1387-1392
        • Bradman K.
        • Maconochie I.
        Can paediatric early warning score be used as a triage tool in paediatric accident and emergency?.
        European Journal of Emergency Medicine. 2008; 15: 359-360
        • Chapman S.M.
        • Grocott M.P.
        • Franck L.S.
        Systematic review of paediatric alert criteria for identifying hospitalised children at risk of critical deterioration.
        Intensive Care Medicine. 2010; 36: 600-611
        • Duncan H.
        • Hutchison J.
        • Parshuram C.S.
        The pediatric early warning system score: A severity of illness score to predict urgent medical need in hospitalized children.
        Journal of Critical Care. 2006; 21: 271-278
        • Egdell P.
        • Finlay L.
        • Pedley D.K.
        The PAWS score: Validation of an early warning scoring system for the initial assessment of children in the emergency department.
        Emergency Medicine Journal. 2008; 25: 745-749
        • Haines C.
        • Perrott M.
        • Weir P.
        Promoting care for acutely ill children-development and evaluation of a paediatric early warning tool.
        Intensive & Critical Care Nursing. 2006; 22: 73-81
        • Hoot N.R.
        • Aronsky D.
        Systematic review of emergency department crowding: Causes, effects, and solutions.
        Annals of Emergency Medicine. 2008; 52: 126-136
        • Kellett J.
        • Clifford M.
        • Ridley A.
        • Gleeson M.
        Validation of the VitalPACTM early warning score (ViEWS) in acutely ill medical patients admitted.
        Irish Medical Journal. 2013; 106 (PMID: 24579416): 318
        • Monaghan A.
        Detecting and managing deterioration in children.
        Paediatric Nursing. 2005; 17: 32-35
        • Oldroyd C.
        • Day A.
        The use of pediatric early warning scores in the emergency department.
        Journal of Emergency Nursing. 2011; 37 (quiz 424.): 374-376
        • Otyek M.
        • Nansubuga G.
        • Kellett and John.
        Validation of the VitalPAC (TM) early warning score (ViEWS) in acutely ill medical patients attending a resource-poor hospital in sub-Saharan Africa.
        Resuscitation. 2013; 2013: 743-746
        • Pearson G.
        Why Children Die: the report of a pilot confidential enquiry into child death by CEMACH (Confidential Enquiry into Maternal and Child Health)..
        14. 2008: 5
        • Prytherch D.R.
        • Smith G.B.
        • Schmidt P.E.
        • Featherstone P.I.
        ViEWS—Towards a national early warning score for detecting adult inpatient deterioration.
        Resuscitation. 2010; 81: 932-937
        • Reis A.G.
        • Nadkarni V.
        • Perondi M.B.
        • Grisi S.
        • Berg R.A.
        A prospective investigation into the epidemiology of in-hospital pediatric cardiopulmonary resuscitation using the international Utstein reporting style.
        Pediatrics. 2002; 109: 200-209
        • Seiger N.
        • Maconochie I.
        • Oostenbrink R.
        • Moll H.A.
        Validity of different pediatric early warning scores in the emergency department.
        Pediatrics. 2013; 132: e841-e850
        • Skaletzky S.M.
        • Raszynski A.
        • Totapally B.R.
        Validation of a modified pediatric early warning system score: A retrospective case-control study.
        Clinical Pediatrics (Phila). 2012; 51: 431-435
        • Tamul P.C.
        • Leonard C.
        Ventilators, Acute Medical Care. American Cancer Society.
        2022
        • Tibballs J.
        • Kinney S.
        • Duke T.
        • Oakley E.
        • Hennessy M.
        Reduction of pediatric in-patient cardiac arrest and death with a medical emergency team: preliminary results.
        Archives of Disease in Childhood. 2005; 90: 1148-1152
        • Tucker K.M.
        • Brewer T.L.
        • Baker R.B.
        • Demeritt B.
        • Vossmeyer M.T.
        Prospective evaluation of a pediatric inpatient early warning scoring system.
        Journal for Specialists in Pediatric Nursing. 2009; 14: 79-85
        • Wang Y.
        • Liu Y.
        • Ye D.
        • Li N.
        • Bi P.
        • Tong S.
        • Yao X.
        Temperatures and health costs of emergency department visits: A multisite time series study in China.
        Environmental Research. 2021; 197111023
        • Weiss S.J.
        • Ernst A.A.
        • Sills M.R.
        • Quinn B.J.
        • Johnson A.
        • Nick T.G.
        Development of a novel measure of overcrowding in a pediatric emergency department.
        Pediatric Emergency Care. 2007; 23: 641-645