Accuracy of a pediatric early warning score in the recognition of clinical deterioration

Miranda, Juliana de Oliveira Freitas; Camargo, Climene Laura de; Sobrinho, Carlito Lopes Nascimento; Portela, Daniel Sales; Monaghan, Alan

doi:10.1590/1518-8345.1733.2912

Cited by 22 publications

(35 citation statements)

References 23 publications

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“…NEWS could be incorporated into the patient report forms used by emergency medical services, which would be akin to the bedside observation charts used in many hospitals. In addition, further consideration should be given to whether NEWS can be used all patient groups, since some studies suggest that population specific early warning scores should be used in hospital, for example PEWS in paediatric patients, MEOWS in obstetric patients and CREWS in patients with COPD [ [16] , [17] , [18] ]. From the point of view of the hospital physician, our results suggest that pre-hospital NEWS is not a better marker of clinical status compared to NEWS calculated on admission to hospital.…”

Section: Discussionmentioning

confidence: 99%

Pre-hospital National Early Warning Score (NEWS) is associated with in-hospital mortality and critical care unit admission: A cohort study

Abbott

Cron

Vaid

et al. 2018

Annals of Medicine and Surgery

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BackgroundNational Early Warning Score (NEWS) is increasingly used in UK hospitals. However, there is only limited evidence to support the use of pre-hospital early warning scores. We hypothesised that pre-hospital NEWS was associated with death or critical care escalation within the first 48 h of hospital stay.MethodsPlanned secondary analysis of a prospective cohort study at a single UK teaching hospital. Consecutive medical ward admissions over a 20-day period were included in the study. Data were collected from ambulance report forms, medical notes and electronic patient records. Pre-hospital NEWS was calculated retrospectively. The primary outcome was a composite of death or critical care unit escalation within 48 h of hospital admission. The secondary outcome was length of hospital stay.Results189 patients were included in the analysis. The median pre-hospital NEWS was 3 (IQR 1–5). 13 patients (6.9%) died or were escalated to the critical care unit within 48 h of hospital admission. Pre-hospital NEWS was associated with death or critical care unit escalation (OR, 1.25; 95% CI, 1.04–1.51; p = 0.02), but NEWS on admission to hospital was more strongly associated with this outcome (OR, 1.52; 95% CI, 1.18–1.97, p < 0.01). Neither was associated with hospital length of stay.ConclusionPre-hospital NEWS was associated with death or critical care unit escalation within 48 h of hospital admission. NEWS could be used by ambulance crews to assist in the early triage of patients requiring hospital treatment or rapid transport. Further cohort studies or trials in large samples are required before implementation.

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Section: Discussionmentioning

confidence: 99%

Pre-hospital National Early Warning Score (NEWS) is associated with in-hospital mortality and critical care unit admission: A cohort study

Abbott

Cron

Vaid

et al. 2018

Annals of Medicine and Surgery

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“…26,28 In Brazil, some abstracts publications were found in congress annals, but few publications in journals about the use of early warning scores to recognize pediatric clinical deterioration. [15][16]29 However, certain studies have described the profile of pediatric patients admitted to the hospital or intensive care unit, [7][8][9][10][11][12] These events are considered indicators of worsening of the hospitalized child's clinical condition. Some of the results of these studies corroborate data already described in the literature and evidenced by this research.…”

Section: Discussionmentioning

confidence: 99%

“…All the children participating in the study were assessed by applying the translated, adapted, and validated version of the Brighton Pediatric Early Warning Score to the Brazilian context -BPEWS-Br (Chart 1) for the purpose of identifying signs of clinical deterioration, [15][16] given the difficulty in establishing well-defined criteria that serve as a reference to determine such an event. 17 Chart 1 -Brighton Pediatric Early Warning Score to the Brazilian context (BPEWS-Br).…”

Section: Methodsmentioning

confidence: 99%

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Factors Associated With the Clinical Deterioration Recognized by an Early Warning Pediatric Score

Miranda

Camargo

Sobrinho

et al. 2020

Texto contexto - enferm.

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Objective: To identify the factors associated with clinical deterioration recognized by a Pediatric Early Warning Score. Method: A cross-sectional study conducted in a tertiary pediatric public hospital with 271 children aged from zero to ten, hospitalized between May and October 2015. For the identification of the children with and without signs of clinical deterioration, the translated, adapted and validated version of the Brighton Pediatric Early Warning Score was applied to the Brazilian context. Logistic regression analysis and prevalence ratio (PR) were used to measure the association between the variables studied. A 95% Confidence Interval (CI) and p value were adopted as a measure of statistical significance to identify potential associated factors. Results: The factors associated with the clinical deterioration of the children studied were age ≤ 2 years old (p=0.000), hospitalization in the emergency unit (p=0.000), comorbidity (p=0.020) and clinical diagnosis of respiratory disease (p=0.000). Conclusion: Children ≤ 2 years old, with comorbidity, diagnosed with respiratory disease and hospitalized in the emergency unit showed an increased likelihood of clinical deterioration. The identification of factors associated with clinical deterioration may alert and direct the health team to children more susceptible to this phenomenon.

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“…Authors of multiple single-center studies have reported potential benefits of using PEWS to identify hospitalized children at risk for deterioration. [16][17][18][19][20][21][22] PEWS redirects care team members' attention to patients who are at risk for a more in-depth evaluation of changes in the patient' s condition, 23 empowers nurses to escalate care up the hierarchy of the care team, 24 and provides standardized language when escalating care. 25 However, there is conflicting evidence on the superiority of PEWS at identifying deterioration compared with provider intuition and clinical recognition, 26,27 and care team members may not feel that acuity scores like PEWS are helpful in patients who are well appearing or those with abnormal physiology due to chronic underlying conditions.…”

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confidence: 99%

The Association Between Fever and Subsequent Deterioration Among Hospitalized Children With Elevated PEWS

Lockwood

Reese

Wathen

et al. 2019

Hospital Pediatrics

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A B S T R A C TOBJECTIVES: To evaluate the association between fever and subsequent deterioration among patients with Pediatric Early Warning Score (PEWS) elevations to $4 to inform improvements to care escalation processes at our institution. METHODS:We performed a cohort study of hospitalized children at a single quaternary children's hospital with PEWS elevations to $4 between January 1, 2014 and March 31, 2014. Bivariable analysis was used to compare characteristics between patients with and without unplanned ICU transfers and critical deterioration events (CDEs) (ie, unplanned ICU transfers with life-sustaining interventions initiated in the first 12 ICU hours). A multivariable Poisson regression was used to assess the relative risk of unplanned ICU transfers and CDEs. RESULTS:The study population included 220 PEWS elevations from 176 unique patients. Of those, 33% had fever (n 5 73), 40% experienced an unplanned ICU transfer (n 5 88), and 19% experienced CDEs (n 5 42). Bivariable analysis revealed that febrile patients were less likely to experience an unplanned ICU transfer than those without fever. The same association was found in multivariable analysis with only marginal significance (adjusted relative risk 0.68; 95% confidence interval 0.45-1.01; P 5 .058). There was no difference in the CDE risk for febrile versus afebrile patients (adjusted relative risk 0.79; 95% confidence interval 0.43-1.44; P 5 .44). CONCLUSIONS:At our institution, patients with an elevated PEWS appeared less likely to experience an unplanned ICU transfer if they were febrile. We were underpowered to evaluate the effect on CDEs. These findings contributed to our recognition that (1) PEWS may not include all relevant clinical factors used for clinical decision-making regarding care escalation and (2) further study is needed in this area. the section head of pediatric hospital medicine who assisted with the study design and provided mentorship; Mr Thomas is a biostatistician who performed the statistical analysis; Ms Wathen is a clinical practice specialist in the PICU at Children' s Hospital Colorado who assisted in study design and data collection; Dr Brittan is a pediatric hospitalist who assisted with the study design and data analysis; Ms Iwanowski is a quality improvement specialist who assisted in the study design and data collection; Dr McLeod is a pediatric hospitalist who assisted with study design, assisted with data analysis, and provided mentorship; and all authors approved the final manuscript as submitted. Total PEWS, median (IQR) 4.0 (4.0-5.0) PEWS subset scores, median (IQR) Cardiovascular 1.0 (1.0-1.0) Respiratory 2.0 (1.0-3.0) Behavior 1.0 (1.0-2.0) Change from previous PEWS, median (IQR) 2.0 (1.0-3.0)Acute HHFNC, n (%) 61 (28) Continuous albuterol, n (%) 19 (9) Nighttime event, n (%) 99 (45) IQR, interquartile range.

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Accuracy of a pediatric early warning score in the recognition of clinical deterioration

Cited by 22 publications

References 23 publications

Pre-hospital National Early Warning Score (NEWS) is associated with in-hospital mortality and critical care unit admission: A cohort study

Pre-hospital National Early Warning Score (NEWS) is associated with in-hospital mortality and critical care unit admission: A cohort study

Factors Associated With the Clinical Deterioration Recognized by an Early Warning Pediatric Score

The Association Between Fever and Subsequent Deterioration Among Hospitalized Children With Elevated PEWS

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