Paediatric Early Warning System Research Articles

An Audit of a Modified Pediatric Early Warning Scoring System in a Tertiary Pediatric Hospital.

Pediatric early warning systems identify patients at risk for deterioration. We aimed to determine if a locally adapted pediatric early warning system [KK hospital early warning score (KEWS)] can distinguish patients who require transfer from general ward to high dependency unit (HDU) or PICU, from those who do not. We conducted a retrospective case-control single-center audit. All unplanned general ward to PICU/HDU transfer from January to December 2021 were included as cases. We collected KEWS at the time of transfer and at 2, 4 and 6 hours prior to transfer. Univariate and multivariable logistic regression with imputation analysis were performed to identify variables associated with unplanned PICU/HDU transfer. There were 784 patients (196 cases and 588 controls). Median age of cases and controls were 3.3 (interquartile range: 1.0-9.7) and 3.9 (0.8-11.3) years, respectively. At the time of transfer, median (interquartile range) KEWS for cases and controls were 3 (0, 4) and 0 (0, 1), respectively (P <.001). At all timepoints, KEWS was able to distinguish between children who did and did not require transfer to HDU/PICU (At time of transfer: area under the curve = 0.80, 95% CI = 0.75-0.85, P <.001). After adjusting for age, category of admission, frequency of ordered monitoring, KEWS predicted HDU/PICU transfer with an odds ratio of 2.34 (95% CI 1.82 to 3.00, P <.001). KEWS was able to distinguish patients requiring transfer from GW to HDU/PICU from those not needing a transfer.

Feasibility and acceptability of implementing an evidence-based ESCALATION system for paediatric clinical deterioration.

The ESCALATION system is a novel paediatric Early Warning System that incorporates family involvement and sepsis recognition. This study aimed to assess the feasibility and iteratively refine the ESCALATION system in a variety of hospital settings in preparation for full-service implementation. A series of four multi-methods studies using an Implementation Science and co-design approach were conducted. We examined concepts of implementation, context, and mechanisms of action across a variety of hospitals. Data collected included practice and chart audits, surveys (health professionals), interviews (families) and focus groups (health professionals). Quantitative data were analysed descriptively with qualitative findings assessed by content analysis or thematic analysis. There were 650 audits (Study I-IV), 205 health professional survey responses (Study I), 154 health professionals participated in focus groups (Study II-IV), 13 parents of hospitalised children interviewed (Study I), and 107 parents reported their involvement in the ESCALATION system (Study III-IV). Each of the studies further refined and confirmed the feasibility, specifically the components of family involvement and the sepsis recognition pathway. The Implementation Science evaluation of the ESCALATION system resulted in a uniform approach that was feasible and acceptable to users and appropriate for full-service implementation. This series of four studies used a co-production approach built on the Medical Research Council framework to understand feasibility and acceptability of an intervention to improve recognition and response to clinical deterioration in children to the point of full-service implementation. We have reported a detailed, systematic approach to assessing feasibility and acceptability of a complex intervention using established methodologies for whole of health system implementation. The ESCALATION System is an evidence based paediatric early warning system that is a highly refined, well accepted and accommodates a health system that has substantial contextual variation.

Assessing children who are acutely ill in general practice using the National PEWS and LqSOFA clinical scores: a retrospective cohort study.

Clinical tools are needed in general practice to help identify children who are seriously ill. The Liverpool quick Sequential Organ Failure Assessment (LqSOFA) was validated in an emergency department and performed well. The National Paediatric Early Warning System (PEWS) has been introduced in hospitals throughout England with hopes for implementation in general practice. To validate the LqSOFA and National PEWS in general practice. Secondary analysis of 6703 children aged <5 years presenting to 225 general practices in England and Wales with acute illnesses, linked to hospital data. Variables from the LqSOFA and National PEWS were mapped onto study data to calculate score totals. A primary outcome of admission within 2 days of GP consultation was used to calculate sensitivity, specificity, negative predictive values (NPVs), positive predictive values (PPVs), and area under the receiver operating characteristic curve (AUC). A total of 104/6703 children were admitted to hospital within 2 days (pre-test probability 1.6%) of GP consultation. The sensitivity of the LqSOFA was 30.6% (95% confidence interval [CI] = 21.8% to 41.0%), with a specificity of 84.7% (95% CI = 83.7% to 85.6%), PPV of 3.0% (95% CI = 2.1% to 4.4%), NPV of 98.7% (95% CI = 98.4% to 99.0%), and AUC of 0.58 (95% CI = 0.53 to 0.63). The sensitivity of the National PEWS was 81.0% (95% CI = 71.0% to 88.1%), with a specificity of 32.5% (95% CI = 31.2% to 33.8%), PPV of 1.9% (95% CI = 1.5% to 2.5%), NPV of 99.1% (95% CI = 98.4% to 99.4%), and AUC of 0.66 (95% CI = 0.59 to 0.72). Although the NPVs appear useful, owing to low pre-test probabilities rather than discriminative ability, neither tool accurately identified admissions to hospital. Unconsidered use by GPs could result in unsustainable referrals.

Using clinical simulation to assess a new paediatric ESCALATION system education package: Empirical research mixed methods.

The aim of the study was to assess the suitability of an online education package to prepare health professionals to use a new paediatric early warning system. Quasi-experimental mixed methods using co-production. Participants completed the Package and participated in up to four clinical scenarios. Data were collected using self-report surveys, and during clinical scenarios; escalation of care, documentation, family involvement, communication handovers were assessed, and recorded debriefings were thematically analysed. Data were integrated using tabulated joint displays. Eleven nurses and three doctors were recruited from three mixed adult and paediatric hospitals. Following completion of the Package and clinical scenarios 13/14 (93%) participants agreed preparedness and confidence to use the ESCALATION System had increased. For 53% handovers, the communication framework was followed, for 79% charts, documentation was complete. Participants engaged with the parent (actor) for 97% scenario interactions. The Package was effective and participation in clinical scenarios appeared to enhance learning. Consumers participated in the steering group overseeing the study and in the expert panel who reviewed the education package and clinical scenarios.

Sustainability determinants of an intervention to identify clinical deterioration and improve childhood cancer survival in Latin American hospitals: the INSPIRE study protocol

BackgroundMore than 90% of children with cancer live in low-resourced settings, where survival is only 20%. Sustainable evidence-based (EB) interventions yielding ongoing beneficial patient outcomes are critical to improve childhood cancer survival. A better understanding of factors promoting intervention sustainability in these settings is urgently needed. The aim of this study is to provide an empirical understanding of how clinical capacity for sustainability, or the resources needed to sustain an intervention, impacts the sustainment of Pediatric Early Warning System (PEWS), an EB intervention that improves pediatric oncology outcomes in low-resource hospitals by detecting clinical deterioration and preventing the need for more intense treatment.MethodsWe will conduct a prospective, longitudinal study of approximately 100 resource-variable hospitals implementing and sustaining PEWS participating in Proyecto EVAT, a quality improvement collaborative of Latin American pediatric oncology centers. Aim 1: We will evaluate how clinical capacity for sustainability changes over time through 5 to 9 prospective measurements of capacity via survey of clinical staff using PEWS (approximately n = 13 per center) during the phases of PEWS adoption, implementation, and sustainability using the Clinical Sustainability Assessment Tool (CSAT). Aim 2: We will determine the relationship between capacity and a) PEWS sustainment and b) clinical deterioration mortality among pediatric oncology patients at centers sustaining PEWS for 2 to 10 years using chart review and an existing patient outcomes registry. Aim 3: We will develop novel strategies to promote sustainability by gaining a deeper understanding of perceived challenges to building capacity and PEWS sustainment. In combination with quantitative outcomes, we will conduct 24 focus groups with staff (doctors, nurses, and administrators) from hospitals with both high (n = 4) and low capacity (n = 4). We will then use implementation mapping to generate theoretically driven, empirically-supported sustainability strategies.DiscussionThis study will advance implementation science by providing a theoretically driven, foundational understanding of factors that predict sustainability among a large, diverse cohort of hospitals. We will then use this knowledge to develop sustainability evidence-informed strategies that optimize capacity and promote long-term sustainment of PEWS and improvements in patient outcomes, thus promoting equity in childhood cancer care globally.

Connecting Clinical Capacity and Intervention Sustainability in Resource-Variable Pediatric Oncology Centers in Latin America

Clinical capacity for sustainability, or the clinical resources needed to sustain an evidence-based practice, represent proximal determinants that contribute to intervention sustainment. We examine the relationship between clinical capacity for sustainability and sustainment of PEWS, an evidence-based intervention to improve outcomes for pediatric oncology patients in resource-variable hospitals. We conducted a cross-sectional survey among Latin American pediatric oncology centers participating in Proyecto Escala de Valoración de Alerta Temprana (EVAT), an improvement collaborative to implement Pediatric Early Warning Systems (PEWS). Hospitals were eligible if they had completed PEWS implementation. Clinicians were eligible to participate if they were involved in PEWS implementation or used PEWS in clinical work. The Spanish-language survey consisted of 56 close and open-ended questions about the respondent, hospital, participants’ assessment of clinical capacity to sustain PEWS using the clinical sustainability assessment tool (CSAT), and perceptions about PEWS and its use as an intervention. Results were analyzed using a multi-level modeling approach to examine the relationship between individual, hospital, intervention, and clinical capacity determinants to PEWS sustainment. A total of 797 responses from 37 centers in 13 countries were included in the analysis. Eighty-seven percent of participants reported PEWS sustainment. After controlling for individual, hospital, and intervention factors, clinical capacity was significantly associated with PEWS sustainment (OR 3.27, p < .01). Marginal effects from the final model indicate that an increasing capacity score has a positive influence (11% for every additional CSAT point) of predicting PEWS sustainment. PEWS is a sustainable intervention and clinical capacity to sustain PEWS contributes meaningfully to PEWS sustainment.

Pediatric vital signs monitoring in hospital wards: Recognition systems and factors influencing nurses' attitudes and practices

AimsTo describe: 1) systems in place for recognition and response to deteriorating children in Italy, 2) attitudes and practices of registered nurses (RN) towards vital signs (VS) monitoring in pediatric wards, 3) the associations of nurses attitudes and pratices with nurses' and organizational characteristics. Design and methodsA multicentre cross-sectional correlational study. Data were collected between January–May 2020 using: an adapted version of the ‘Survey on Recognition and Response Systems in Australia’, and the ‘Ped-V Scale’. Descriptive and adjusted linear regression analysis was performed, accounting for clustering. ResultsTen Italian hospitals participated, 432 RNs responded to the Ped-V scale (response rate = 52%). Five (50%) hospitals had a VS policy in place, three hospitals (30%) had a Pediatric Early Warning System (PEWS), almost all hospitals had a system in place to respond to deteriorating children. Following multivariate regression analysis, having a PEWS was significantly associated with Ped-V scale ‘Workload’, ‘Clinical competence’, ‘Standardization’ dimensions; gender was associated with ‘key indicators’ and pediatric surgical ward with ‘Clinical competence’. ConclusionsThe use of VS policies and PEWS was not consistent across hospitals caring for children in Italy. Nurses' attitudes and practices (i.e., perception of workload, and clinical competence) were significantly lower in hospitals with increased complexity of care/PEWS. Gender was significantly associated with knowledge scores. Practice implicationsSystem strategies to improve nurses' attitudes and practices towards VS monitoring and education are warranted to support effective behaviors towards VS monitoring, their interpretation, and appropriate communication to activate the efferent limb of the rapid response system.

Pediatric Early Warning System in the Short Stay Unit

INTRODUCTION: Pediatric Early Warning Scores were developed as standardized clinical aides for early recognition of clinical deterioration in children. These systems improve situational awareness among professionals. A major concern is the workload increase. After implementation in the Short Stay Unit, we intended to evaluate its effectiveness in our population.METHODS: We reviewed medical records of children admitted to the Short Stay Unit between July 2017 and February 2020. We developed a statistical analysis to evaluate the test performance.RESULTS: One thousand three hundred twenty-three patients were included (median age 3.07 years-old); 5.7% were considered to have clinical deterioration (maximum score median 7.00 vs 2.00) (p&lt;0.001). The area under the ROC curve was 0.947. Defining 4 as cut-off value, the sensitivity is 97.1% (specificity 82.7%).CONCLUSION: This score proved to be a good test for early identification of clinical deterioration in our population.

Evaluation of a modified paediatric early warning score for children with congenital heart disease.

Paediatric early warning score systems are used for early detection of clinical deterioration of patients in paediatric wards. Several paediatric early warning scores have been developed, but most of them are not suitable for children with cyanotic CHD who are adapted to lower arterial oxygen saturation. The present study compared the original paediatric early warning system of the Royal College of Physicians of Ireland with a modification for children with cyanotic CHD. Retrospective single-centre study in a paediatric cardiology intermediate care unit at a German university hospital. The distribution of recorded values showed a significant shift towards higher score values in patients with cyanotic CHD (p < 0.001) using the original score, but not with the modification. An analysis of sensitivity and specificity for the factor "requirement of action" showed an area under the receiver operating characteristic for non-cyanotic patients of 0.908 (95% CI 0.862-0.954). For patients with cyanotic CHD, using the original score, the area under the receiver operating characteristic was reduced to 0.731 (95% CI 0.637-0.824, p = 0.001) compared to 0.862 (95% CI 0.809-0.915, p = 0.207), when the modified score was used. Using the critical threshold of scores ≥ 4 in patients with cyanotic CHD, sensitivity and specificity for the modified score was higher than for the original (sensitivity 78.8 versus 72.7%, specificity 78.2 versus 58.4%). The modified score is a uniform scoring system for identifying clinical deterioration, which can be used in children with and without cyanotic CHD.

Effect of paediatric early warning systems (PEWS) implementation on clinical deterioration event mortality among children with cancer in resource-limited hospitals in Latin America: a prospective, multicentre cohort study

Paediatric early warning systems (PEWS) aid in the early identification of clinical deterioration events in children admitted to hospital. We aimed to investigate the effect of PEWS implementation on mortality due to clinical deterioration in children with cancer in 32 resource-limited hospitals across Latin America. Proyecto Escala de Valoración de Alerta Temprana (Proyecto EVAT) is a quality improvement collaborative to implement PEWS in hospitals providing childhood cancer care. In this prospective, multicentre cohort study, centres joining Proyecto EVAT and completing PEWS implementation between April 1, 2017, and May 31, 2021, prospectively tracked clinical deterioration events and monthly inpatient-days in children admitted to hospital with cancer. De-identified registry data reported between April 17, 2017, and Nov 30, 2021, from all hospitals were included in analyses; children with limitations on escalation of care were excluded. The primary outcome was clinical deterioration event mortality. Incidence rate ratios (IRRs) were used to compare clinical deterioration event mortality before and after PEWS implementation; multivariable analyses assessed the correlation between clinical deterioration event mortality and centre characteristics. Between April 1, 2017, and May 31, 2021, 32 paediatric oncology centres from 11 countries in Latin America successfully implemented PEWS through Proyecto EVAT; these centres documented 2020 clinical deterioration events in 1651 patients over 556 400 inpatient-days. Overall clinical deterioration event mortality was 32·9% (664 of 2020 events). The median age of patients with clinical deterioration events was 8·5 years (IQR 3·9-13·2), and 1095 (54·2%) of 2020 clinical deterioration events were reported in male patients; data on race or ethnicity were not collected. Data were reported per centre for a median of 12 months (IQR 10-13) before PEWS implementation and 18 months (16-18) after PEWS implementation. The mortality rate due to a clinical deterioration event was 1·33 events per 1000 patient-days before PEWS implementation and 1·09 events per 1000 patient-days after PEWS implementation (IRR 0·82 [95% CI 0·69-0·97]; p=0·021). In the multivariable analysis of centre characteristics, higher clinical deterioration event mortality rates before PEWS implementation (IRR 1·32 [95% CI 1·22-1·43]; p<0·0001), being a teaching hospital (1·18 [1·09-1·27]; p<0·0001), not having a separate paediatric haematology-oncology unit (1·38 [1·21-1·57]; p<0·0001), and having fewer PEWS omissions (0·95 [0·92-0·99]; p=0·0091) were associated with a greater reduction in clinical deterioration event mortality after PEWS implementation; no association was found with country income level (IRR 0·86 [95% CI 0·68-1·09]; p=0·22) or clinical deterioration event rates before PEWS implementation (1·04 [0·97-1·12]; p=0·29). PEWS implementation was associated with reduced clinical deterioration event mortality in paediatric patients with cancer across 32 resource-limited hospitals in Latin America. These data support the use of PEWS as an effective evidence-based intervention to reduce disparities in global survival for children with cancer. American Lebanese Syrian Associated Charities, US National Institutes of Health, and Conquer Cancer Foundation. For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.

Stages of change: Strategies to promote use of a Pediatric Early Warning System in resource-limited pediatric oncology centers.

Pediatric Early Warning Systems (PEWS) assist early detection of clinical deterioration in hospitalized children with cancer. Relevant to successful PEWS implementation, the "stages of change" model characterizes stakeholder support for PEWS based on willingness and effort to adopt the new practice. At five resource-limited pediatric oncology centers in Latin America, semi-structured interviews were conducted with 71 hospital staff involved in PEWS implementation. Purposive sampling was used to select centers requiring variable time to complete PEWS implementation, with low-barrier centers (3-4 months) and high-barrier centers (10-11 months). Interviews were conducted in Spanish, professionally transcribed, and translated into English. Thematic content analysis explored "stage of change" with constant comparative analysis across stakeholder types and study sites. Participants identified six interventions (training, incentives, participation, evidence, persuasion, and modeling) and two policies (environmental planning and mandates) as effective strategies used by implementation leaders to promote stakeholder progression through stages of change. Key approaches involved presentation of evidence demonstrating PEWS effectiveness, persuasion and incentives addressing specific stakeholder interests, enthusiastic individuals serving as models for others, and policies enforced by hospital directors facilitating habitual PEWS use. Effective engagement targeted hospital directors during early implementation phases to provide programmatic legitimacy for clinical staff. This study identifies strategies to promote adoption and maintained use of PEWS, highlighting the importance of tailoring implementation strategies to the motivations of each stakeholder type. These findings can guide efforts to implement PEWS and other evidence-based practices that improve childhood cancer outcomes in resource-limited hospitals.

Impact of hospital characteristics on implementation of a Pediatric Early Warning System in resource-limited cancer hospitals.

Pediatric Early Warning Systems (PEWS) aid in identification of deterioration in hospitalized children with cancer but are underutilized in resource-limited settings. Proyecto EVAT is a multicenter quality improvement (QI) collaborative in Latin America to implement PEWS. This study investigates the relationship between hospital characteristics and time required for PEWS implementation. This convergent mixed-methods study included 23 Proyecto EVAT childhood cancer centers; 5 hospitals representing quick and slow implementers were selected for qualitative analysis. Semi-structured interviews were conducted with 71 stakeholders involved in PEWS implementation. Interviews were recorded, transcribed and translated to English, then coded using a priori and novel codes. Thematic content analysis explored the impact of hospital characteristics and QI experience on time required for PEWS implementation and was supplemented by quantitative analysis exploring the relationship between hospital characteristics and implementation time. In both quantitative and qualitative analysis, material and human resources to support PEWS significantly impacted time to implementation. Lack of resources produced various obstacles that extended time necessary for centers to achieve successful implementation. Hospital characteristics, such as funding structure and type, influenced PEWS implementation time by determining their resource-availability. Prior hospital or implementation leader experience with QI, however, helped facilitate implementation by assisting implementers predict and overcome resource-related challenges. Hospital characteristics impact time required to implement PEWS in resource-limited childhood cancer centers; however, prior QI experience helps anticipate and adapt to resource challenges and more quickly implement PEWS. QI training should be a component of strategies to scale-up use of evidence-based interventions like PEWS in resource-limited settings.

Evaluation of a Paediatric Early Warning System (PEWS) score on admission to a paediatric intensive care unit to predict mortality risk in a low resource setting, Guinea-Bissau

The Paediatric Early Warning System (PEWS) is a clinical monitoring tool used routinely in emergency and observation rooms to detect rapid deterioration in paediatric patients, allowing timely action

The COVID-19 Pandemic's impact on sustainability and expansion of a Pediatric Early Warning System in resource-limited hospitals.

The COVID-19 pandemic impacted healthcare delivery worldwide, including pediatric cancer care, with a disproportionate effect in resource-limited settings. This study evaluates its impact on existing quality improvement (QI) programs. We conducted 71 semi-structured interviews of key stakeholders at five resource-limited pediatric oncology centers participating in a collaborative to implement Pediatric Early Warning System (PEWS). Interviews were conducted virtually using a structured interview guide, recorded, transcribed, and translated into English. Two coders developed a codebook of a priori and inductive codes and independently coded all transcripts, achieving a kappa of 0.8-0.9. Thematic analysis explored the impact of the pandemic on PEWS. All hospitals reported limitations in material resources, reduction in staffing, and impacts on patient care due to the pandemic. However, the impact on PEWS varied across centers. Identified factors that promoted or limited ongoing PEWS use included the availability of material resources needed for PEWS, staff turnover, PEWS training for staff, and the willingness of staff and hospital leaders to prioritize PEWS. Consequently, some hospitals were able to sustain PEWS; others halted or reduced PEWS use to prioritize other work. Similarly, the pandemic delayed plans at all hospitals to expand PEWS to other units. Several participants were hopeful for future expansion of PEWS post-pandemic. The COVID-19 pandemic created challenges for sustainability and scale of PEWS, an ongoing QI program, in these resource-limited pediatric oncology centers. Several factors mitigated these challenges and promoted ongoing PEWS use. These results can guide strategies to sustain effective QI interventions during future health crises.

Key considerations for developing patient management tools for small and nutritionally at-risk infants: A scoping review

Background: To improve global child health, efficacious interventions are important but real-world effectiveness is crucial; this requires translating technical guidance into frontline clinical and patient care practices. Patient management ‘tools’ are frequently used for this purpose, guiding healthcare workers to deliver quality care. Ahead of an update to a patient management tool for small and nutritionally at-risk infants under six months of age (C-MAMI Tool, V2), we reviewed how others have done this in the past. Our aim was to ensure an evidence-based development process to optimise future success and impact.&#x0D; Methods: We investigated five patient management tools: Integrated Care Pathways (ICPs), Integrated Management of Childhood Illness (IMCI), Paediatric Early Warning Systems (PEWS), Growth Monitoring (GM), and Emergency Triage Assessment and Treatment (ETAT). Searches were run in PubMed and examined evidence on the development, uptake, and effectiveness of these tools.&#x0D; Results: The tools were developed between approximately 1960-2005, with ongoing development of electronic patient management tools (e-tools). IMCI and ETAT were the most widely used in low- and middle-income countries (LMICs), but low coverage remains a major barrier to effectiveness. Growth monitoring is also widely used in LMICs but lacks strong evidence of effectiveness. Evidence on the use of e-tools for patient management in LMICs is growing. Whilst overall evidence for all these approaches was limited, the strongest evidence of effectiveness was for ICPs. Though evidence was sparse, formative work developing the tools prior to implementation seems important to their future success.&#x0D; Conclusions: Informed by this review, the C-MAMI Tool was updated to the MAMI Care Pathway Package, using an ICP approach and modelled on IMCI. This living resource continues to evolve: aligning with and accounting for existing pathways and systems; baseline formative user-experience research; formal effectiveness research to actively plan for future scale up; collecting information on variance from and adaptations to the care pathway; possible future e-tools. An ICP approach is relevant to other child health and nutrition topics.

The value of Pediatric Early Warning Score combined with SBAR in neonatal pneumonia nursing: A retrospective cohort study.

To observe the effect of the Pediatric Early Warning System (PEWS) score combined with the situation-background-assessment-recommendation (SBAR) shift communication system in neonates with severe pneumonia in the pediatric intensive care unit. A total of 230 neonates admitted to the pediatric intensive care unit of our hospital from January 2018 to January 2021 were enrolled in this study. Participants were divided into an experimental group (110 patients, PEWS score combined with SBAR shift communication system) and a control group (120 patients, routine diagnosis and treatment and shift change). The early recognition rate, incidence of handover problems, and prognosis of critically ill children in the 2 groups were analyzed. Compared to the control group, the correct recognition rate of disease observation and early recognition rate of critically ill children in the experimental group were significantly higher, and the incidence of handover problems was significantly lower (P < .05). There was no significant difference in the incidence of asphyxia, heart failure, and toxic encephalopathy between both groups. The application of the PEWS score combined with the SBAR shift communication system can facilitate timely identification of deterioration of the condition of children with severe pneumonia, reduce handover problems, and help to implement interventions or rescue according to the changes in a patient's condition, which may be beneficial in improving the patient's prognosis.

MORTALITY PROFILE AND ITS CORRELATION WITH BPEWS SCORE IN PEDIATRIC INTENSIVE CARE UNIT OF TERTIARY CARE CENTRE

Introduction: The care of critically ill children remains one of the most demanding and challenging aspects in the field of Pediatrics. In spite of availability of well-equipped Pediatric Intensive Care Units (PICU), deaths do occur. Aims/objective:To study the mortality profiles and its correlation to the Bedside Pediatric Early Warning System Score (BPEWS) in children who expired within 48 hours of admission.Inclusion criteria:children aged1 month to 12 years who expired within 48 hours of admission in PICU of a tertiary care center.Methods:Approval from the institutional ethics committee was obtained prior to commencement of the study.Retrospective data of consecutive children aged 1 month to 12 years who expired within 48 hours, was collected from the hospital's Medical Records Section. The variables necessary for BPEWS Score calculator were noted and the BPEWS Score was calculated. Result: 84% patients were below five years of age with mean age of 2.6 year and 57% were females. Mean duration of stay was 19.68 hours. Mean distance from health facility was 8.31 km. Respiratory system was affected in the majority of patients (47%). More than forty percent of children were undernourished. Mean BPEWS score was 17.36 in the age group of 1 to 5 year, which depicts poor outcome. Conclusion: Majority of early deaths (within 48hrs) occurred in patients less than five years of age.Higher BPEWS (&gt;8) was associated with shorter duration of stay of patients and poor outcome

Опыт стандартизации подходов к раннему выявлению рисков клинического ухудшения у пациентов детского возраста в инфекционном стационаре

In recent years, healthcare professionals are actively developing new systemic approaches to monitor vital signs at the bedside of a sick child by a nurse. One of these approaches is the Pediatric Early Warning Systems (PEWS). Objective. To standardize approaches to early detection of risks and timely prevention of clinical deterioration in children treated in hospitals for infectious diseases using the PEWS scale. Patients and methods. This study was conducted between September 28 and October 29, 2021 in the Pediatric Department for Infectious Diseases, Central Clinical Hospital No 40 and included 749 patients aged from 1 month to 19 years. The majority of patients were under 6 years of age. MS Excel 2021 was used for statistical analysis. Fisher's exact test with Yate's correction was used to identify significant changes. Results. As many as 352 patients (47.0 ± 1.8%) had no risk for poor prognosis (PEWS 0). We found no significant differences between the groups of children studied (acute upper respiratory infection, unspecified, n = 412; other and unspecified gastroenteritis and colitis of infectious origin, n = 233) in the frequency of PEWS scores. Thirteen out of 25 patients with PEWS ≥5 were admitted to the intensive care unit, whereas the remaining 12 patients received timely adequate care in specialized departments. Conclusion. Our first experience with the PEWS scale allows us to recommend it for pediatric hospitals. The PEWS scale is aimed at early detection of clinical signs associated with a risk of possibly deterioration in children treated in the departments of infectious diseases and helps to identify patients that require more extensive examination and treatment. Key words: children, infection, monitoring, risks, condition, scale, deterioration

Arriving Safely: Decreasing Rapid Escalations in Care for Incoming Transported Pediatric Patients.

We created an escalation algorithm utilizing PEWS scores and direct lines of communication between emergency medical technicians and receiving physicians. Audit and feedback increased the adoption of the process. We defined rapid escalations as transfer to a higher level of care within 6 hours of admission. PEWS score completion increased from a mean of 48% to 70%. This result varied by emergency medical technician crew level of care. Eleven percent (n = 114) of PEWS scores required physician notification, 20% (n = 23) of which resulted in interventions en route. There were no differences in rapid escalation rates over time, but it remained low at <2% of all incoming transported patients. Some crew members report improved communication with hospital providers and feel more empowered to speak up when a patient's assessment is not as expected following algorithm implementation. This project improved PEWS score completion and maintained a low rate of rapid escalations of care among incoming transfers.

Evaluating the usefulness of the pediatric early warning system (PEWS) for predicting clinical deterioration and mortality in febrile neutropenia

Evaluating the usefulness of the pediatric early warning system (PEWS) for predicting clinical deterioration and mortality in febrile neutropenia