Abstract
IntroductionThe timely provision of critical care to hospitalised patients at risk for cardiopulmonary arrest is contingent upon identification and referral by frontline providers. Current approaches require improvement. In a single-centre study, we developed the Bedside Paediatric Early Warning System (Bedside PEWS) score to identify patients at risk. The objective of this study was to validate the Bedside PEWS score in a large patient population at multiple hospitals.MethodsWe performed an international, multicentre, case-control study of children admitted to hospital inpatient units with no limitations on care. Case patients had experienced a clinical deterioration event involving either an immediate call to a resuscitation team or urgent admission to a paediatric intensive care unit. Control patients had no events. The scores ranged from 0 to 26 and were assessed in the 24 hours prior to the clinical deterioration event. Score performance was assessed using the area under the receiver operating characteristic (AUCROC) curve by comparison with the retrospective rating of nurses and the temporal progression of scores in case patients.ResultsA total of 2,074 patients were evaluated at 4 participating hospitals. The median (interquartile range) maximum Bedside PEWS scores for the 12 hours ending 1 hour before the clinical deterioration event were 8 (5 to 12) in case patients and 2 (1 to 4) in control patients (P < 0.0001). The AUCROC curve (95% confidence interval) was 0.87 (0.85 to 0.89). In case patients, mean scores were 5.3 at 20 to 24 hours and 8.4 at 0 to 4 hours before the event (P < 0.0001). The AUCROC curve (95% CI) of the retrospective nurse ratings was 0.83 (0.81 to 0.86). This was significantly lower than that of the Bedside PEWS score (P < 0.0001).ConclusionsThe Bedside PEWS score identified children at risk for cardiopulmonary arrest. Scores were elevated and continued to increase in the 24 hours before the clinical deterioration event. Prospective clinical evaluation is needed to determine whether this score will improve the quality of care and patient outcomes.
Highlights
The timely provision of critical care to hospitalised patients at risk for cardiopulmonary arrest is contingent upon identification and referral by frontline providers
There were 23,288 hours with data describing one or more of the Bedside Bedside Paediatric Early Warning System (PEWS) score items, 7,263 hours (31.2%) when 5 or more of the items of the Bedside PEWS score were used for score calculation, and 1,181 hours (5.1%) when all 7 items were used for score calculation
In our evaluation of 2,074 patients, we found that, with at least one hour’s notice, the Bedside PEWS score could distinguish ‘sick’ from ‘well’ hospitalised patients and that this score increased during the time leading up to events and was consistently high in case patients independently of the number of risk factors for near and actual cardiopulmonary arrest
Summary
The timely provision of critical care to hospitalised patients at risk for cardiopulmonary arrest is contingent upon identification and referral by frontline providers. In a single-centre study, we developed the Bedside Paediatric Early Warning System (Bedside PEWS) score to identify patients at risk. Application of critical care improves patient outcomes [1,2,3,4] but depends upon early identification of patients at risk [5,6]. In the development data set, in a single-centre study, this seven-item scale was found to have an area under the receiver operating characteristic (AUCROC) curve of 0.91 and a sensitivity of 83% at a score of 8 [6]
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