Abstract
IntroductionAdverse outcomes following clinical deterioration in children admitted to hospital wards is frequently preventable. Identification of children for referral to critical care experts remains problematic. Our objective was to develop and validate a simple bedside score to quantify severity of illness in hospitalized children.MethodsA case-control design was used to evaluate 11 candidate items and identify a pragmatic score for routine bedside use. Case-patients were urgently admitted to the intensive care unit (ICU). Control-patients had no 'code blue', ICU admission or care restrictions. Validation was performed using two prospectively collected datasets.ResultsData from 60 case and 120 control-patients was obtained. Four out of eleven candidate-items were removed. The seven-item Bedside Paediatric Early Warning System (PEWS) score ranges from 0–26. The mean maximum scores were 10.1 in case-patients and 3.4 in control-patients. The area under the receiver operating characteristics curve was 0.91, compared with 0.84 for the retrospective nurse-rating of patient risk for near or actual cardiopulmonary arrest. At a score of 8 the sensitivity and specificity were 82% and 93%, respectively. The score increased over 24 hours preceding urgent paediatric intensive care unit (PICU) admission (P < 0.0001). In 436 urgent consultations, the Bedside PEWS score was higher in patients admitted to the ICU than patients who were not admitted (P < 0.0001).ConclusionsWe developed and performed the initial validation of the Bedside PEWS score. This 7-item score can quantify severity of illness in hospitalized children and identify critically ill children with at least one hours notice. Prospective validation in other populations is required before clinical application.
Highlights
Adverse outcomes following clinical deterioration in children admitted to hospital wards is frequently preventable
The score increased over 24 hours preceding urgent paediatric intensive care unit (PICU) admission (P < 0.0001)
The objective of this study was to AUCROC: area under the receiver operating characteristics curve; CCRT: Critical Care Response Team; CRT: capillary refill time; IQR: interquartile range; PEWS: Paediatric Early Warning System; PICU: paediatric intensive care unit
Summary
Adverse outcomes following clinical deterioration in children admitted to hospital wards is frequently preventable. Our objective was to develop and validate a simple bedside score to quantify severity of illness in hospitalized children. Clinical deterioration resulting in near or actual cardiopulmonary arrest in hospitalised children is common [1], associated with adverse outcome [2,3] and may be preventable [4,5,6,7]. Identification and referral of children may be facilitated by the application of calling criteria or severity of illness scores. Our group previously developed a 16-item severity of illness score for use in hospitalised children [4]. It had favourable performance characteristics; its complexity was felt to limit clinical application [10]. The objective of this study was to AUCROC: area under the receiver operating characteristics curve; CCRT: Critical Care Response Team; CRT: capillary refill time; IQR: interquartile range; PEWS: Paediatric Early Warning System; PICU: paediatric intensive care unit
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