Validity and effectiveness of paediatric early warning systems and track and trigger tools for identifying and reducing clinical deterioration in hospitalised children: a systematic review

Abstract

ObjectiveTo assess (1) how well validated existing paediatric track and trigger tools (PTTT) are for predicting adverse outcomes in hospitalised children, and (2) how effective broader paediatric early warning systems are at reducing adverse outcomes in hospitalised children.DesignSystematic review.Data sourcesBritish Nursing Index, Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effectiveness, EMBASE, Health Management Information Centre, Medline, Medline in Process, Scopus and Web of Knowledge searched through May 2018.Eligibility criteriaWe included (1) papers reporting on the development or validation of a PTTT or (2) the implementation of a broader early warning system in paediatric units (age 0–18 years), where adverse outcome metrics were reported. Several study designs were considered.Data extraction and synthesisData extraction was conducted by two independent reviewers using template forms. Studies were quality assessed using a modified Downs and Black rating scale.Results36 validation studies and 30 effectiveness studies were included, with 27 unique PTTT identified. Validation studies were largely retrospective case-control studies or chart reviews, while effectiveness studies were predominantly uncontrolled before-after studies. Metrics of adverse outcomes varied considerably. Some PTTT demonstrated good diagnostic accuracy in retrospective case-control studies (primarily for predicting paediatric intensive care unit transfers), but positive predictive value was consistently low, suggesting potential for alarm fatigue. A small number of effectiveness studies reported significant decreases in mortality, arrests or code calls, but were limited by methodological concerns. Overall, there was limited evidence of paediatric early warning system interventions leading to reductions in deterioration.ConclusionThere are several fundamental methodological limitations in the PTTT literature, and the predominance of single-site studies carried out in specialist centres greatly limits generalisability. With limited evidence of effectiveness, calls to make PTTT mandatory across all paediatric units are not supported by the evidence base.PROSPERO registration numberCRD42015015326

Measuring vital signs in children with fever at the emergency department: an observational study on adherence to the NICE recommendations in Europe

“…Even though the level of evidence for the diagnostic accuracy of vital signs is varying, their importance is widely acknowledged [6]. Vital signs form the basis of paediatric early warning scores (PEWS) that are widely used to monitor disease severity of children in the inpatient setting [7]. Moreover, they are included in several prediction models for serious infections and in disease-specific guidelines for the ED setting [3,[8][9][10][11][12].…”

Modern View on the Role of Epidermal Barrier in Atopic Phenotype Development in Children

“…Раннему выявлению факторов риска развития неблагоприятных событий способствуют системы раннего предупреждения (Pediatric Early Warning Score, PEWS), которые основаны на периодической регистрации витальных показателей пациентов и вычисления суммы частоты их отклонений от референсных значений [2]. Различные модификации систем раннего предупреждения учитывают частоту сердечных сокращений (ЧСС), частоту дыхания (ЧД), температуру тела, систолическое (САД) и диастолическое (ДАД) артериальное давление, уровень сатурации кислородом пульсирующей артериальной крови (SpO 2 ) [3]. Эффективность указанных систем в клинической практике, в том числе и в отделениях интенсивной терапии, доказана [4].…”

“…Оценка витальных показателей В числе витальных показателей анализировали ЧСС, ЧД, SpO 2 и температуру тела (используются в PEWS [3]), а также САД и ДАД. В качестве референсных интервалов для ЧСС и ЧД использовали данные [7,8] (табл.…”

“…Отклонения витальных показателей у пациентов отделения анестезиологии и реанимации с низким и высоким риском летального исхода (по шкале PIM3): ретроспективное когортное исследование Оригинальная статья Д.В. Прометной 1,2,3 , Ю.С. Александрович 2…”

Implementation and adherence to the Bedside Paediatric Early Warning System (BedsidePEWS) in a pediatric tertiary care hospital

“…Some evidence of PEWS effectiveness was reported in a systematic review where PEWS were part of a wider systems approach involving a Rapid Response Team (RRT) or Medical Emergency Team (MET) ready to respond to deteriorating patients, with a potential to reduce 31 deaths/10.000 hospital admissions [7]. However, evidence is limited since most studies are single-centered and mainly performed in specialist hospitals [8]. No studies to date have described the implementation of the BedsidePEWS in a tertiary care pediatric hospital.…”