Paediatric early warning systems: not a simple answer to a complex question

Roland, Damian; Powell, Colin; Lloyd, Amy; Trubey, Rob; Tume, Lyvonne N.; Sefton, Gerri; Huang, Chao; Taiyari, Katie; Strange, Heather; Jacob, Nina; Thomas-Jones, Emma; Hood, Kerenza; Allen, Davina

doi:10.1136/archdischild-2022-323951

Arch Dis Child

2022

DOI: 10.1136/archdischild-2022-323951

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Paediatric early warning systems: not a simple answer to a complex question

Damian Roland

Colin Powell

Amy Lloyd

et al.

Abstract: Paediatric early warning systems (PEWS) to reduce in-hospital mortality have been a laudable endeavour. Evaluation of their impact has rarely examined the internal validity of the components of PEWS in achieving desired outcomes. We highlight the assumptions made regarding the mode of action of PEWS and, as PEWS become more commonplace, this paper asks whether we really understand their function, process and outcome.

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Evaluation of a modified paediatric early warning score for children with congenital heart disease

Commotio,

Leister,

Menzel

et al. 2023

Cardiol Young

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Background: Paediatric early warning score systems are used for early detection of clinical deterioration of patients in paediatric wards. Several paediatric early warning scores have been developed, but most of them are not suitable for children with cyanotic CHD who are adapted to lower arterial oxygen saturation. Aim: The present study compared the original paediatric early warning system of the Royal College of Physicians of Ireland with a modification for children with cyanotic CHD. Design: Retrospective single-centre study in a paediatric cardiology intermediate care unit at a German university hospital. Results: The distribution of recorded values showed a significant shift towards higher score values in patients with cyanotic CHD (p < 0.001) using the original score, but not with the modification. An analysis of sensitivity and specificity for the factor “requirement of action” showed an area under the receiver operating characteristic for non-cyanotic patients of 0.908 (95% CI 0.862–0.954). For patients with cyanotic CHD, using the original score, the area under the receiver operating characteristic was reduced to 0.731 (95% CI 0.637–0.824, p = 0.001) compared to 0.862 (95% CI 0.809–0.915, p = 0.207), when the modified score was used. Using the critical threshold of scores ≥ 4 in patients with cyanotic CHD, sensitivity and specificity for the modified score was higher than for the original (sensitivity 78.8 versus 72.7%, specificity 78.2 versus 58.4%). Conclusion: The modified score is a uniform scoring system for identifying clinical deterioration, which can be used in children with and without cyanotic CHD.

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Evaluation of a modified paediatric early warning score for children with congenital heart disease

Commotio,

Leister,

Menzel

et al. 2023

Cardiol Young

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Not too sick, not too well: reducing the diagnostic void in pediatric emergency medicine

Roland,

Horeczko,

Snelson

2024

Pediatr Res

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Emergency clinicians must rapidly evaluate the acutely ill or injured child. In a resource-stressed environment, “spotting the sick child” is essential for appropriate stabilization, treatment, and further management. Overlooking clinical features in a child’s presentation may impede timely care. Complicating factors include the volume of patients seeking care, unfettered access to emergency services, parental perceptions and expectations, and clinician biases. Notwithstanding, after an appropriate history and physical exam, some children do not fall under the standard rubric of “sick or not sick”. This article explores strategies to recognise the child who may lie in the diagnostic void between those who are obviously well and those who are not.

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Paediatric early warning systems: not a simple answer to a complex question

Cited by 2 publications

References 30 publications

Evaluation of a modified paediatric early warning score for children with congenital heart disease

Evaluation of a modified paediatric early warning score for children with congenital heart disease

Not too sick, not too well: reducing the diagnostic void in pediatric emergency medicine

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