Systematic review of paediatric track and trigger systems for hospitalised children

Chapman, Sue; Wray, Jo; Oulton, Kate; Peters, Mark

doi:10.1016/j.resuscitation.2016.07.230

Cited by 80 publications

(96 citation statements)

References 71 publications

(17 reference statements)

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“…PEWS were identified through our recent systematic review 2. We excluded a priori PEWS where vital signs were assessed subjectively or against individual patient baseline values.…”

Section: Methodsmentioning

confidence: 99%

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‘The Score Matters’: wide variations in predictive performance of 18 paediatric track and trigger systems

et al. 2017

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Objective To compare the predictive performance of 18 paediatric early warning systems (PEWS) in predicting critical deterioration. Design Retrospective case-controlled study. PEWS values were calculated from existing clinical data, and the area under the receiver operator characteristic curve (AUROC) compared. Setting UK tertiary referral children's hospital. Patients Patients without a 'do not attempt resuscitation' order admitted between 1 January 2011 and 31 December 2012. All patients on paediatric wards who suffered a critical deterioration event were designated 'cases' and matched with a control closest in age who was present on the same ward at the same time.Main outcome measures Respiratory and/or cardiac arrest, unplanned transfer to paediatric intensive care and/or unexpected death. Results 12 'scoring' and 6 'trigger' systems were suitable for comparative analysis. 297 case events in 224 patients were available for analysis. 244 control patients were identified for the 311 events. Three PEWS demonstrated better overall predictive performance with an AUROC of 0.87 or greater. Comparing each system with the highest performing PEWS with Bonferroni's correction for multiple comparisons resulted in statistically significant differences for 13 systems. Trigger systems performed worse than scoring systems, occupying the six lowest places in the AUROC rankings. Conclusions There is considerable variation in the performance of published PEWS, and as such the choice of PEWS has the potential to be clinically important. Trigger-based systems performed poorly overall, but it remains unclear what factors determine optimum performance. More complex systems did not necessarily demonstrate improved performance.

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“…PEWS were identified through our recent systematic review 2. We excluded a priori PEWS where vital signs were assessed subjectively or against individual patient baseline values.…”

Section: Methodsmentioning

confidence: 99%

“…Paediatric early warning systems (PEWS) should alert staff to deteriorating children and accelerate access to appropriate intervention 1. Despite weak evidence,2 3 they are widely recommended 4–8. In 2013, 85% of UK centres caring for children were using PEWS 9…”

Section: Introductionmentioning

confidence: 99%

‘The Score Matters’: wide variations in predictive performance of 18 paediatric track and trigger systems

et al. 2017

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“…Much of the PEWS literature has concentrated on specialist children’s hospitals 4. Two recent systematic reviews on PEWS and similar ‘track and trigger’ systems to identify deterioration in hospitalised children have been undertaken.…”

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

confidence: 99%

“…Two recent systematic reviews on PEWS and similar ‘track and trigger’ systems to identify deterioration in hospitalised children have been undertaken. The first identified 33 distinct PEWS from 55 papers 4. The second identified 38 primary studies on original and/or modified PEWS from 90 papers 2.…”

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

confidence: 99%

“…The threshold for ‘abnormality’ is generally higher than that seen in score-based PEWS in order to prevent excessive false alarms. Both score-based and trigger-based PEWS rely on regular universal surveillance of patients to ‘track’ their progress and ‘trigger’ a sequence of events when predetermined criteria are met 4. Some indicators, such as heart and respiratory rate, may require age-appropriate criteria.…”

Section: Introductionmentioning

confidence: 99%

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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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Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings

et al. 2022

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IMPORTANCE Pediatric early warning systems (PEWS) aid with early identification of clinical deterioration and improve outcomes in children with cancer hospitalized in resource-limited settings; however, there may be barriers to implementation. OBJECTIVE To evaluate stakeholder-reported barriers and enablers to PEWS implementation in resource-limited hospitals. DESIGN, SETTING, AND PARTICIPANTSIn this qualitative study, semistructured stakeholder interviews were conducted at 5 resource-limited pediatric oncology centers in 4 countries in Latin America. Hospitals participating in a multicenter collaborative to implement PEWS were purposefully sampled based on time required for implementation (fast vs slow), and stakeholders interviewed included physicians, nurses, and administrators, involved in PEWS implementation. An interview guide was developed using the Consolidated Framework for Implementation Research (CFIR).Interviews were conducted virtually in Spanish, audiorecorded, and professionally transcribed and translated into English. A codebook was developed a priori using the CFIR and supplemented with codes inductively derived from transcript review. Two coders independently analyzed all transcripts, achieving a κ of 0.8 to 0.9. The study was conducted from June 1 to August 31, 2020. MAIN OUTCOMES AND MEASURES Thematic analysis was conducted based on CFIR domains(inner setting, characteristics of individuals, outer setting, intervention characteristics, and implementation process) to identify barriers and enablers to PEWS implementation. RESULTSSeventy-one staff involved in PEWS implementation were interviewed, including 32 physicians (45%), 32 nurses (45%), and 7 administrators (10%). Of these, 50 were women (70%).Components of the 5 CFIR domains were mentioned by participants as barriers and enablers to PEWS implementation at both fast-and slow-implementing centers. Participants emphasized barriers at the level of the clinical staff, hospital, external factors, and PEWS intervention. These barriers included staff resistance to change, inadequate resources, components of health systems, and the perceived origin and complexity of PEWS. At all centers, most barriers were successfully converted to enablers during the implementation process through targeted strategies, such as early stakeholder engagement and adaptation, including adapting PEWS to better fit the local context and changing the hospital setting to support ongoing use of PEWS. CONCLUSIONS AND RELEVANCETo date, this is the first multicenter, multinational study describing barriers and enablers to PEWS implementation in resource-limited settings. Findings suggest that many barriers are not immutable and can be converted to enablers during the (continued) Key Points Question What barriers and enablers to pediatric early warning systems (PEWS) implementation in resource-limited hospitals are reported by health care professionals? Findings In this qualitative study including 5 resource-limited pediatric oncology centers in 4 countries in Latin America, ma...

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Systematic review of paediatric track and trigger systems for hospitalised children

Cited by 80 publications

References 71 publications

‘The Score Matters’: wide variations in predictive performance of 18 paediatric track and trigger systems

‘The Score Matters’: wide variations in predictive performance of 18 paediatric track and trigger systems

Early warning scores in paediatrics: an overview

Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings

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