Paediatric early warning systems (PEWS and Trigger systems) for the hospitalised child: time to focus on the evidence

Lillitos, Peter J; Maconochie, Ian

doi:10.1136/archdischild-2016-312136

Cited by 6 publications

(2 citation statements)

References 6 publications

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“…ROC for a score at 1 h had AUC of 0.788 and cutoff score derived was 2 with sensitivity -61.9% and specificity -88.89. A similar retrospective study done by Lillitos et al [16] in two UK EDs also showed that PEWS over 2 had good specificity but poor sensitivity in predicting decline in clinical status. Most of the other studies which used [17,18].…”

Section: Discussionsupporting

confidence: 52%

Validation of Brighton pediatric early warning score for predicting clinical deterioration in the emergency department

Duraisamy¹,

Vanaja²,

Samy³

et al. 2021

Indian J Child Health

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Pediatric early warning score is a standardized score assigned to a patient through assessment of various physiological, behavioral, and clinical parameters. These warning systems facilitate early detection of clinical deterioration. These scores have proven to improve multidisciplinary team work, communication, and confidence in recognizing, reporting, and making decisions about a child at risk of clinical deterioration [1,2]. Different pediatric early warning scores (PEWSs) were developed, modified, and validated in various places across the globe, with majority of contributions from developed countries [3][4][5][6][7][8][9][10][11]. There is a wide heterogeneity in PEWS used with regard to the number of parameters settings where they are applied and the outcomes measured. However, not all of them could be applied in resource restricted settings because of the need for special equipment and technical expertise. Brighton PEWS tool is a simple clinical score involving three parameters, which can be easily performed even by nurses without the need for special equipment [6].Most of the studies have implemented Brighton PEWS in pediatric inpatient units [6,7]. There is a paucity of literature regarding the implementation of PEWS in pediatric ED; especially, in the Indian population. In resource-limited settings where specialists may not be available, registered medical practitioners or nursing personnel may be the first personnel to encounter pediatric patients. Availability of simple and validated clinical tool becomes crucial to identify the children at risk of deterioration in such settings. Hence, this study was designed to assess the validity of Brighton's PEWS tool in predicting clinical deterioration in children admitted from emergency departments (EDs) and to assess the interobserver agreement between nurses administered PEWS and pediatric trainee administered PEWS.

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Section: Discussionsupporting

confidence: 52%

Validation of Brighton pediatric early warning score for predicting clinical deterioration in the emergency department

Duraisamy¹,

Vanaja²,

Samy³

et al. 2021

Indian J Child Health

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“…Finally, with increasing availability of technology, smartphone apps that contain standard medical guidelines can be developed using m-health platforms that allow easy administration of CRS particularly in resource-limited EDs, in order to save time and effort. In an era in which the merits of paediatric early warning scores are still actively debated [ 25 ], we feel our study provides a potential practical answer in an LMIC setting.…”

Section: Discussionmentioning

confidence: 98%

The clinical respiratory score predicts paediatric critical care disposition in children with respiratory distress presenting to the emergency department

Nayani¹,

Naeem

Munir

et al. 2018

BMC Pediatr

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BackgroundRespiratory distress is a common presenting complaint in children brought to the Emergency Department (ED). The Clinical Respiratory Score (CRS) has shown promise as a screen for severe illness in High Income Countries. We aimed to validate the admission CRS in children presenting to the ED of a Low-to Middle Income Country.MethodsChildren (1 month to 16 years) presenting with respiratory distress to the ED of the Aga Khan University Hospital, Karachi, Pakistan, between November 2015 to March 2016, were enrolled. The CRS was measured at initial presentation, prior to any management and 2 h after treatment was started. The predictive value for admission to the paediatric critical care units for a variety of cut offs for CRS at presentation were derived.ResultsA total of 112 children (70% male) of median age 12 months (IQR 2, 34.5 months) were enrolled. Patients with severe CRS (score 8–12) at presentation were more likely to be admitted to paediatric critical care (90% vs. 23% with mild-moderate CRS; OR: 5.7; 95% CI: 2.2–15.3, p < 0.001). The sensitivity and specificity of CRS > 3 in predicting outcome were 94% (95% CI 79.8–99.3) and 40% (95% CI 35–45), respectively, with a positive likelihood ratio of 1.6 (95% CI 1.31–1.98) and negative predictive value of 94% (95% CI 81–98).ConclusionAn admission CRS of > 3 in the ED of a Low-to Middle Income Country had excellent predictive value for disease severity, and it should be considered for incorporation into ED triage protocols.

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Development and validation of a Paediatric Early Warning Score for use in the emergency department: a multicentre study

Zachariasse

Nieboer

Maconochie

et al. 2020

The Lancet Child & Adolescent Health

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Paediatric early warning systems (PEWS and Trigger systems) for the hospitalised child: time to focus on the evidence

Cited by 6 publications

References 6 publications

Validation of Brighton pediatric early warning score for predicting clinical deterioration in the emergency department

Validation of Brighton pediatric early warning score for predicting clinical deterioration in the emergency department

The clinical respiratory score predicts paediatric critical care disposition in children with respiratory distress presenting to the emergency department

Development and validation of a Paediatric Early Warning Score for use in the emergency department: a multicentre study

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