Can paediatric early warning scores (PEWS) be used to guide the need for hospital admission and predict significant illness in children presenting to the emergency department? An assessment of PEWS diagnostic accuracy using sensitivity and specificity

Lillitos, Peter J; Hadley, Graeme; Maconochie, Ian

doi:10.1136/emermed-2014-204355

Cited by 38 publications

(58 citation statements)

References 26 publications

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“…This study improves on the methodology employed in previous preliminary work12 where the authors retrospectively assigned a classification of ‘minor’ or ‘significant’ along with a physiological system to diagnoses of children presenting to that ED during the study period. It was recognised that if prospective work on PEWS was to be undertaken, there was a need for a more standardised list of conditions, created using a systematic methodology to reflect a broader consensus of expert opinion, hence the purpose of this current work.…”

Section: Discussionmentioning

confidence: 99%

“…Previous work12 was called on to act as a template to classify diagnoses into illness categories (eg, respiratory) and then we as a study group created the list of diagnoses we thought were significant and covered the majority of ED presentations. Round 1 consisted of 161 statements on clinical conditions from the following 17 illness and injury categories: infection, respiratory, cardiac, gastroenterology, neurology, trauma, surgery, allergy, dermatology, endocrine and metabolic, toxicology, musculoskeletal, haematology, renal, safeguarding, mental health and miscellaneous.…”

Section: Methodsmentioning

confidence: 99%

“…For ED purposes, most scores have been retrospectively modelled, the endpoints chosen for validation purposes are variable and poorly defined,10 with the studies showing varying accuracy between different scoring systems in identifying the sick child or the child who requires hospital admission 11–14. In one such study,12 the authors compiled their own list of significant illness definitions, which they then used as a benchmark to assess PEWS performance. It is unknown however whether their list is reflective of a broader group of expert opinion and there is currently no agreed or standardised list of significant paediatric conditions, illnesses or injuries in existence, against which the efficacy of PEWS and the systems around the use of such scores can be measured.…”

Section: Introductionmentioning

confidence: 99%

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Defining significant childhood illness and injury in the Emergency Department: a consensus of UK and Ireland expert opinion

et al. 2018

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BackgroundClarifying whether paediatric early warning scores (PEWS) accurately predict significant illness is a research priority for UK and Ireland paediatric emergency medicine (EM). However, a standardised list of significant conditions to benchmark these scores does not exist.ObjectivesTo establish standardised significant illness endpoints for use in determining the performance accuracy of PEWS and safety systems in emergency departments (ED), using a consensus of expert opinion in the UK and Ireland.DesignBetween July 2017 and February 2018, three online Delphi rounds established a consensus on ‘significant’ clinical conditions, derived from a list of common childhood illness/injury ED presentations. Conditions warranting acute hospital admission in the opinion of the respondent were defined as ‘significant’, using a 5-point Likert scale. The consensus was a priori ≥80% (positive or negative). 258 clinical conditions were tested.Participants and settingsEligible participants were consultants in acute or EM paediatrics, or adult EM, accessed via 53 PERUKI (Paediatric Emergency Research in the UK and Ireland)’s research collaborative sites, and 27 GAPRUKI (General and Adolescent Paediatric Research in the UK and Ireland)’s sites, 17 of which overlap with PERUKI.Main outcome measuresTo create a list of conditions regarded as ‘significant’with ≥80% expert consensus.Results43 (68%) of 63 PERUKI and GAPRUKI sites responded; 295 experts were invited to participate. Participants in rounds 1, 2 and 3 were 223 (76%), 177 (60%) and 148 (50%), respectively; 154 conditions reached positive consensus as ‘significant’; 1 condition reached a negative consensus (uncomplicated Henoch-Schönlein purpura); and 37 conditions achieved non-consensus.ConclusionsA list of significant childhood conditions has been created using UK and Irish expert consensus, for research purposes, for the first time. This will be used as the benchmark endpoint list for future research into PEWS/safety systems performance in EDs.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Defining significant childhood illness and injury in the Emergency Department: a consensus of UK and Ireland expert opinion

et al. 2018

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“…Two differing PEWS underwent a head-to-head comparison to see if they could act when used on an undifferentiated population 15. Both Brighton and Children’s Observation and Severity Tool PEWS scores performed similarly.…”

Section: Where Are They Used and How Do They Perform?mentioning

confidence: 99%

Early warning scores in paediatrics: an overview

Chapman

Maconochie

2018

Arch Dis Child

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Paediatric Early Warning Scores (PEWS)are used in hospitalised patients to detect physiological deterioration and is being used increasingly throughout healthcare systems with a limited evidence based. There are two versions in general use that can lead to a clinical response, either by triggering an action or by reaching a ‘threshold’ when graduated responses may occur depending on the value of the score. Most evidence has come from research based on paediatric inpatients in specialist children’s hospitals, although the range of research is expanding, taking into account other clinical areas such as paediatric intensive care unit, emergency department and the prehospital setting. Currrently, it is uncertain whether a unified system does deliver benefits in terms of outcomes or financial savings, but it may inform and improve patient communication. PEWS may be an additional tool in context of a patient’s specific condition, and future work will include its validation for different conditions, different clinical settings, patient populations and organisational structure. The incorporation of PEWS within the electronic health records may form a keystone of the safe system framework and allow the development of consistent PEWS system to standardise practice.

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“…In a similar comparison, Lillitos PJ et al looked at two early warning scores in a similarly sized group of children presenting to ED, finding poor sensitivity and specificity in major trauma (Area Under Receiver Operating Curve (AUC) 0.65) 2. In major trauma, descriptors detailing risk factors and mechanisms of injury (eg, ejection from motor vehicle) outperform current PEWS systems; it is worth noting that although the PAT-POPS score was designed primarily for ED use, it has a distinctly medical flavour and does not incorporate recognised mechanisms of significant injury in its list of “specific conditions”, but focuses primarily on respiratory and cardiovascular parameters i.e.…”

mentioning

confidence: 99%