Factors Associated With the Clinical Deterioration Recognized by an Early Warning Pediatric Score

Abstract

Objective: To identify the factors associated with clinical deterioration recognized by a Pediatric Early Warning Score. Method: A cross-sectional study conducted in a tertiary pediatric public hospital with 271 children aged from zero to ten, hospitalized between May and October 2015. For the identification of the children with and without signs of clinical deterioration, the translated, adapted and validated version of the Brighton Pediatric Early Warning Score was applied to the Brazilian context. Logistic regression analysis and prevalence ratio (PR) were used to measure the association between the variables studied. A 95% Confidence Interval (CI) and p value were adopted as a measure of statistical significance to identify potential associated factors. Results: The factors associated with the clinical deterioration of the children studied were age ≤ 2 years old (p=0.000), hospitalization in the emergency unit (p=0.000), comorbidity (p=0.020) and clinical diagnosis of respiratory disease (p=0.000). Conclusion: Children ≤ 2 years old, with comorbidity, diagnosed with respiratory disease and hospitalized in the emergency unit showed an increased likelihood of clinical deterioration. The identification of factors associated with clinical deterioration may alert and direct the health team to children more susceptible to this phenomenon.

Utility of Pediatric Early Warning Sign Score in Predicting Outcome of PICU Admissions at a Suburban Tertiary Care Hospital

“…17 Miranda et al found that an elevated PEWS was associated with clinical signs of deterioration with an AUC of 0.92, sensitivity of 74%, and specificity of 96%. 19 Chaiyakulsil and Pandee in their study in the emergency department of a university hospital found elevated PEWS was associated with admission to the hospital with an AUC of 0.73, sensitivity of 78%, and specificity of 60%, and higher scores were associated with ICU admission, with an AUC of 0.98, sensitivity of 100%, and specificity of 91%. 20 In their review of the PEWS in resource-limited settings, Brown et al suggested that the PEWS may aid in the triage of large numbers of hospitalized patients and help staff identify those who require immediate attention without the need for extensive pediatric experience.…”

A utilização de escore de alerta precoce em cardiologia: revisão integrativa

“…A importância da escala é alertar a equipe e nortear condutas clínicas frente à somatória dos resultados obtidos, possibilitando desfechos mais favoráveis. Estudos mostram a utilização da escala por times de resposta rápida constituída por profissionais da área da saúde, consolidados à rotina assistencial dos grandes hospitais, possibilitando respostas mais positivas e contribuindo para o processo de segurança do paciente (Miranda et al, 2020).…”

“…Para atender pacientes pediátricos nesse cenário, foi desenvolvida uma ferramenta utilizando os mesmos princípios de avaliação de alterações fisiológicas adaptadas à realidade pediátrica, os chamados Pediatric Early Warning Score (PEWS), desenvolvidos e validados a fim de identificar precocemente sinais de alerta em crianças hospitalizadas (Miranda et al, 2020).…”

“…Dentre os PEWS está o Brighton Pediatric Early Warning Score (BPEWS) também conhecido como Monaghan PEWS, que foi publicado em 2005, ele utiliza três componentes da avaliação: neurológico, cardiovascular e respiratório, com uma pontuação de 0 a 13. A partir de 3 pontos, quanto maior a pontuação, maior o risco de deterioração clínica (Miranda et al, 2020;Monaghan, 2005).…”