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

Abstract

A B S T R A C T BACKGROUND:This study compares a Pediatric Early Warning Score (PEWS) to physician opinion in identifying patients at risk for deterioration. METHODS:Maximum PEWS recorded during each admission was retrospectively ascertained from electronic medical record data. Physician opinion regarding risk of subsequent deterioration was determined by assignment to an institutional "senior sign-out" (SSO) list that highlights patients whom senior pediatric residents have identified as at risk. Deterioration events were defined as intubation, initiation of high flow nasal cannula, inotropes, noninvasive mechanical ventilation, or aggressive fluid resuscitation within 12 hours of transfer to the PICU. We assessed the relationships of sociodemographic variables, PEWS, and SSO assignment with subsequent deterioration events using multivariate regression analysis to control for a number of covariates. RESULTS:There were 97 patients with nonelective transfers to the PICU who were eligible for placement on the SSO lists before transfer, 51 of whom experienced qualifying deterioration events. Maximum recorded PEWS was significantly higher for patients with a subsequent deterioration event during the first 12 hours after transfer, compared with those who were transferred but did not experience a deterioration event in the first 12 hours (mean [SD]: 3.9 [2.0] vs 2.9 [2.0]; P 5 .01). This association persisted even after multivariate adjustment. SSO assignment was only marginally associated with risk of deterioration among this patient population, with or without adjustment for covariates. CONCLUSIONS:The PEWS was significantly associated with ICU deterioration, whereas physician opinion was not. Used alone or in conjunction with physician assessment, PEWS is a valuable tool for identifying patients vulnerable to acute deterioration.

Predicting Postoperative Physiologic Decline After Surgery

“…Further investigation is needed to assess which active health issues are identified through a different approach and how the issues affect the likelihood of PoPD. Although the current work is from a single-center tertiary care institution, the study methods and findings may be generalizable to other hospitals, especially those that currently employ or are developing early warning systems to detect physiologic decline in hospitalized patients [39][40][41][42][43] and those that are participating in quality improvement initiatives to standardize patients' preoperative evaluations performed by anesthesiology providers. 44 Moreover, one-half of the patients in our cohort had 0 or only 1 chronic condition; the PoPD findings in those patients may be helpful for hospitals that predominately perform surgeries and related procedures on patients who are less complex.…”

Necessity of Intensive Care Requirement in Childhood Intoxicity

“…26 Patel ve ark. 7 27,28 acil durumda hızlı müdahale eden takımların oluşturulması ve ekip çalışması sayesinde, 9 pek çok hastanın çocuk genel servisi içerisinde güvenle takip edilebileceği düşünülmektedir. 7,29 Çocuklara yönelik zehirlenme şiddet ve risk skorlarının geliştirilmesi ile hangi hastanın yoğun bakım ünitesi yatışına ihtiyaç duyacağının belirlenmesi önem kazanmaktadır.…”

Early prediction of critical events for infants with single-ventricle physiology in critical care using routinely collected data

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