An elevated Pediatric Early Warning Score is associated with ICU transfer and receipt of ICU-specific interventions in patients across different pediatric subspecialty patient populations.

A B S T R A C T BACKGROUND:This study compares a Pediatric Early Warning Score (PEWS) to physician opinion in identifying patients at risk for deterioration. METHODS:Maximum PEWS recorded during each admission was retrospectively ascertained from electronic medical record data. Physician opinion regarding risk of subsequent deterioration was determined by assignment to an institutional "senior sign-out" (SSO) list that highlights patients whom senior pediatric residents have identified as at risk. Deterioration events were defined as intubation, initiation of high flow nasal cannula, inotropes, noninvasive mechanical ventilation, or aggressive fluid resuscitation within 12 hours of transfer to the PICU. We assessed the relationships of sociodemographic variables, PEWS, and SSO assignment with subsequent deterioration events using multivariate regression analysis to control for a number of covariates. RESULTS:There were 97 patients with nonelective transfers to the PICU who were eligible for placement on the SSO lists before transfer, 51 of whom experienced qualifying deterioration events. Maximum recorded PEWS was significantly higher for patients with a subsequent deterioration event during the first 12 hours after transfer, compared with those who were transferred but did not experience a deterioration event in the first 12 hours (mean [SD]: 3.9 [2.0] vs 2.9 [2.0]; P 5 .01). This association persisted even after multivariate adjustment. SSO assignment was only marginally associated with risk of deterioration among this patient population, with or without adjustment for covariates. CONCLUSIONS:The PEWS was significantly associated with ICU deterioration, whereas physician opinion was not. Used alone or in conjunction with physician assessment, PEWS is a valuable tool for identifying patients vulnerable to acute deterioration.

introduction: The aim of the study was to explore how the diagnosis of pulmonary embolism was performed between the period of 2002-2006 and the period of 2008-2012. methods: The examination was carried out in Emergency Department of the Kaposi Mor Teaching Hospital in 2013. After the first time period Wells-score pulmonary embolism risk stratification method and the D-dimer test were adapted and the computer tomography introduced generally in patients suspected PE. Those patients have been included in the investigation who died in the hospital and autopsied in the two examined time periods and their pathological diagnosis was pulmonary embolism. 111 patient's post mortem clinical documents were analyzed. In cases where the physician did not perform risk stratification we calculated a follow-up value. results: We found that despite the fact that included in the protocol, as well as the necessary information was available, the physicians were not even once applied the Wells score, therefore we have a posteriori calculated it for each patient. There were 69 patients (80% from 111) who weren't diagnosed with pulmonary embolism in clinical phase. Conversely from the posterior calculations only 8% of the patients have been included in the low-, 73% of the patients included in the intermediate-, and 19% of the patients included in the high probability group. We have concluded that there was significant difference by the rate of the performed CT (p=0,0002) and D-dimer tests (p=0,001) comparing patients under and above 65 years.. The most common inaccurate diagnoses were: bronchopneumonia (n=10), lung cancer (n=9) and myocardial infarct (n=8). Conclusions: The development of the diagnostic tools and the improvement of their accessibility haven't taken a significant change in the successful clinical diagnosis of pulmonary embolism. The patients above 65 years were more neglected than patients less than 65 years because of their longevity, often their hopeless state of health, and not due to the difference in Wells scores.introduction: To estimate the relation between BMI (Body Mass Index) with length of stay in the ICU and hospital. methods: Patients admitted between Jan, 2012 and July, 2013 were included and data was assessed for retrospective analysis. A total of 878 patients were included and the variables collected included age, gender, APS

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