Development of a score to predict clinical deterioration in hospitalized children

Abstract

BACKGROUND:Identification of the characteristics that put hospitalized children at high risk of deterioration may help to target patients whose physiologic status should be intensively monitored for signs of deterioration, and reduce unnecessary monitoring in patients at very low risk. Previous studies have evaluated vital sign‐based early warning scores to detect deterioration that has already begun.OBJECTIVE:To develop a predictive score for deterioration using non‐vital sign patient characteristics in order to risk‐stratify hospitalized children before signs of deterioration are detectable.DESIGN:Case‐control study.SETTING:A 460‐bed children's hospital.PATIENTS:Cases (n = 141) were children who deteriorated while receiving care on non‐intensive care unit (non‐ICU) inpatient units. Controls (n = 423) were randomly selected.MEASUREMENTS:The exposures were complex chronic conditions, other patient characteristics, and laboratory studies. The outcome was clinical deterioration, defined as cardiopulmonary arrest, acute respiratory compromise, or urgent ICU transfer.RESULTS:The 7‐item score included age <1 year, epilepsy, congenital/genetic conditions, history of transplant, enteral tube, hemoglobin <10 g/dL, and blood culture drawn in the preceding 72 hours. We grouped the patients into risk strata based on their scores. The very low‐risk group's probability of deterioration was less than half of baseline risk. The high‐risk group's probability of deterioration was more than 80‐fold higher than the baseline risk.CONCLUSIONS:We identified a set of characteristics associated with clinical deterioration in children. Used in combination as a score, these characteristics may be useful in triaging the intensity of monitoring and surveillance for deterioration that children receive while hospitalized on non‐ICU units. Journal of Hospital Medicine 2012;

Developing and evaluating a machine learning based algorithm to predict the need of pediatric intensive care unit transfer for newly hospitalized children

“…We did not include lab test results, and an earlier work has explored the predictive potential of lab tests and medications for patient status deterioration. 26 In future works, we will include many more data points for the patients such as lab tests, medications, diagnostic history, social history, and family history.…”

Comparison of Pediatric Early Warning Score to Physician Opinion for Deteriorating Patients

“…However, this was not the case; both SSO and PEWS $5 had relatively low sensitivity. This is concerning because 34 it uses a similar measure that incorporates ICU transfer plus ICU-level interventions instead of ICU transfer only as has been used in many previous studies. 16,17,29,37 Further studies are needed to elucidate the relationship of this measure with morbidity and mortality.…”

“…This is a variation of the critical deterioration metric that has previously been validated and associated with in-hospital mortality 34 but includes the additional measures of HFNC and aggressive fluid resuscitation. Mortality itself was not used because it was a relatively rare event in the pediatric population over the study period.…”

“…Although ICU transfer or RRT/Code activation are classically used as end points of clinically significant deterioration, a recently developed measure of deterioration comprising intubation, positive airway pressure, and/or vasopressor administration has been suggested as a pragmatic proximate measure for mortality and arrest given that these are relatively rare events in the pediatric population. 34 Finally, the interplay between pediatric early warning scores (PEWS) and clinical judgment is less well known, 35 with some evidence suggesting the superiority of clinical judgment in particular settings. 36 The aim of this study was to compare a prospectively validated PEWS tool 6,37 to physician opinion in predicting patient deterioration in the PICU.…”

Pediatric Rapid Response Systems: Identification and Treatment of Deteriorating Children

“…The original PEWS score includes additional diagnostic risk criteria that improves performance in comparison to the similar bedside PEWS and the PEW tool (ROC 0.85 vs. 0.75 vs. 0.73) [22,59]. Similarly, a seven-item non-physiological score identified a group of patients with more than 80-fold higher probability of deterioration compared to the baseline risk [54]. Current EWS, however, focus on acute, generic physiological abnormalities and do not identify changes from previous observations or worrisome trends.…”