The Cardiac Children's Hospital Early Warning Score (C-CHEWS)

McLellan, Mary; Connor, Jean Anne

doi:10.1016/j.pedn.2012.07.009

Cited by 54 publications

(43 citation statements)

References 39 publications

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“…There was one feasibility and reliability testing study, one cost-analysis exercise, one protocol and one course evaluation survey. Of the 90 included papers, 45 focused on PEW detection systems, 2 3 6 7 10 14-53 29 examined PEW response mechanisms 8 54-81 and 16 reported on PEW implementation strategies [82][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97] (see online supplementary appendix 2 for a summary of these studies including the level of evidence and rationale for judgement).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review

et al. 2017

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ObjectiveTo systematically review the available evidence on paediatric early warning systems (PEWS) for use in acute paediatric healthcare settings for the detection of, and timely response to, clinical deterioration in children.MethodThe electronic databases PubMed, MEDLINE, CINAHL, EMBASE and Cochrane were searched systematically from inception up to August 2016. Eligible studies had to refer to PEWS, inclusive of rapid response systems and teams. Outcomes had to be specific to the identification of and/or response to clinical deterioration in children (including neonates) in paediatric hospital settings (including emergency departments). 2 review authors independently completed the screening and selection process, the quality appraisal of the retrieved evidence and data extraction; with a third reviewer resolving any discrepancies, as required. Results were narratively synthesised.ResultsFrom a total screening of 2742 papers, 90 papers, of varied designs, were identified as eligible for inclusion in the review. Findings revealed that PEWS are extensively used internationally in paediatric inpatient hospital settings. However, robust empirical evidence on which PEWS is most effective was limited. The studies examined did however highlight some evidence of positive directional trends in improving clinical and process-based outcomes for clinically deteriorating children. Favourable outcomes were also identified for enhanced multidisciplinary team work, communication and confidence in recognising, reporting and making decisions about child clinical deterioration.ConclusionsDespite many studies reporting on the complexity and multifaceted nature of PEWS, no evidence was sourced which examined PEWS as a complex healthcare intervention. Future research needs to investigate PEWS as a complex multifaceted sociotechnical system that is embedded in a wider safety culture influenced by many organisational and human factors. PEWS should be embraced as a part of a larger multifaceted safety framework that will develop and grow over time with strong governance and leadership, targeted training, ongoing support and continuous improvement.

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Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review

et al. 2017

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“…For this reason, delineation of specific age-based vital sign parameters was intentionally omitted for ease and accuracy of real-time bedside scoring. In line with this thinking, a large portion of published pediatric early warning tools reference a degree of deviation from “normal”, but do not define normal limits (6, 7, 9, 12, 35). This introduces an element of subjectivity for nearly all the sub-categories of these tools, therefore limiting their generalizability to outside institutions.…”

Section: Discussionmentioning

confidence: 99%

Integration of Single-Center Data-Driven Vital Sign Parameters into a Modified Pediatric Early Warning System

Ross

Harrysson

Goel

et al. 2017

Pediatric Critical Care Medicine

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Objective Pediatric early warning systems using expert-derived vital sign parameters demonstrate limited sensitivity and specificity in identifying deterioration. We hypothesized that modified tools using data-driven vital sign parameters would improve the performance of a validated tool. Design Retrospective Case Control Setting Quaternary-care children’s hospital Patients Hospitalized, non-critically ill patients less than 18 years old. Cases were defined as patients who experienced an emergent transfer to an intensive care unit (ICU) or out-of-ICU cardiac arrest. Controls were patients who never required intensive care. Cases and controls were split into training and testing groups. Intervention The Bedside Pediatric Early Warning System (bPEWS) was modified by integrating data-driven heart rate and respiratory rate parameters (modified bPEWS 1 and 2). Modified bPEWS 1 used the 10th and 90th percentiles as normal parameters while modified bPEWS 2 used 5th and 95th percentiles. Measurements and Main Results The training set consisted of 358 case events and 1830 controls; the testing set had 331 case events and 1215 controls. In the sensitivity analysis, 207 of the 331 testing set cases (62.5%) were predicted by the original tool versus 206 (62.2%, p=0.54) with modified bPEWS 1 and 191 (57.7%, p<0.001) with modified bPEWS 2. For specificity, 1005 of the 1215 testing set control patients (82.7%) were identified by original bPEWS versus 1013 (83.1%, p=0.54) with modified bPEWS 1 and 1055 (86.8%, p<0.001) modified bPEWS 2. There was no net gain in sensitivity and specificity using either of the modified bPEWS tools. Conclusions Integration of data-driven vital sign parameters into a validated pediatric early warning system did not significantly impact sensitivity or specificity, and all the tools showed lower than desired sensitivity and specificity at a single cutoff point. Future work is needed to develop an objective tool that can more accurately predict pediatric decompensation.

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“…Using standard thresholds risks over or under reporting physiological deterioration and these unique patients may benefit from customized monitoring plans [43].…”

Section: Normal Abnormal and Normally Abnormal Vital Signsmentioning

confidence: 99%

Pediatric Rapid Response Systems: Identification and Treatment of Deteriorating Children

Levin

Brady

Duncan

et al. 2015

Curr Treat Options Peds

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Opinion statementRapid response systems (RRSs) aim to identify deteriorating hospitalized patients outside of the intensive care unit, respond quickly, and escalate to a higher level of care if needed. Despite a decade of evaluation, how to best design an RRS is still under study and debate. When considering your RRS, our recommendation is to start with the outcomes: what improvements in patient care are most needed in your environment? These may include reducing cardiac arrest or mortality, reducing critical deterioration, reducing length of stay in intensive care, or avoiding all preventable patient harm. Then, select a strategy for identification of at-risk patients, a response team structure that meets your institution's needs, and a quality improvement and governance structure to ensure you monitor process and outcome variables. The identification limb detects at-risk patients. For this, we recommend an aggregate pediatric early warning score (EWS), clear guidance regarding monitoring type and frequency, flagging of diagnostic risk factors, and a mandatory escalation system that uses the expertise of nurses, patients, and families and works around barriers to enhance response team activation. The structure and function of the response limb are also dependent upon the needs of the institution. We recommend a multidisciplinary team with the skills and resources to assess and manage emergencies. Proactive identification through a rover team or scheduled safety huddles may help with earlier identification of at risk patients. The quality improvement and governance structure should be designed around the desired outcomes. Regular monitoring and review of successes, near misses, and failures are vital for the system to improve outcomes.

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The Cardiac Children's Hospital Early Warning Score (C-CHEWS)

Cited by 54 publications

References 39 publications

Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review

Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review

Integration of Single-Center Data-Driven Vital Sign Parameters into a Modified Pediatric Early Warning System

Pediatric Rapid Response Systems: Identification and Treatment of Deteriorating Children

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