Pediatric Early Warning Score and unplanned readmission to the pediatric intensive care unit

Mandell, Iris; Bynum, Francine; Marshall, Lori; Bart, Robert D.; Gold, Jeffrey I.; Rubin, Sarah

doi:10.1016/j.jcrc.2015.06.019

Cited by 41 publications

(38 citation statements)

References 20 publications

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“…However, refuting evidence highlights that EWS validated tools have largely been modified to individual localities whereby the sensitivity and positive predictive values were too low to predict patient deterioration in hospital (Gao et al 2007, Jansen & Cuthberson 2010, Mandell et al 2015. As a result the utility, validity and reliability of EWS tools has been questioned (Gao et al 2007, Donohue & Endacott 2010, Shearer et al 2012, Mandell et al 2015.…”

Section: Ews Validity and Reliability (Mechanism)mentioning

confidence: 99%

Early warning systems and rapid response to the deteriorating patient in hospital: A systematic realist review

McGaughey

O’Halloran

Porter

et al. 2017

Journal of Advanced Nursing

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Section: Ews Validity and Reliability (Mechanism)mentioning

confidence: 99%

Early warning systems and rapid response to the deteriorating patient in hospital: A systematic realist review

McGaughey

O’Halloran

Porter

et al. 2017

Journal of Advanced Nursing

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“…Total scores 0-4 are green, corresponding with the lowest risk patients. Scores 5-7 are yellow, [8][9][10][11] are orange, and 12 are red, with escalating scores indicating greater risk of decompensation. Any total score of 5 or a score of 3 in the neurocognitive or cardiac domain is considered a critical PEWS prompting further assessment from front line provider staff and therapy where clinically appropriate.…”

Section: Me Th O D Smentioning

confidence: 99%

Predicting unplanned readmissions to a pediatric cardiac intensive care unit using predischarge Pediatric Early Warning Scores

Kroeger

Morrison

Smith

2017

Congenital Heart Disease

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Objective: Unplanned readmission to the pediatric cardiac intensive care unit (CICU) is associated with significant morbidity and mortality. The Pediatric Early Warning Score (PEWS) predicts ward patients at risk for decompensation but has not been previously reported to identify at-risk patients with cardiac disease prior to ward transfer. This study aimed to determine whether PEWS prior to transfer may serve as a predictor of unplanned readmission to the CICU.Design: All patients discharged from a tertiary children's hospital CICU from September 2012 through August 2015 were included for analysis. PEWS assessment was performed following transfer to the cardiac ward, and starting in January 2014, PEWS scores were also assigned by bedside CICU nurse prior to transfer from the CICU. Scores exceeding a predetermined threshold prompted further stability assessment by provider team prior to transfer.Results: Among 1320 discharges of 1082 patients during the study period, there were 130 unplanned readmissions during their hospitalization. Following implementation of pretransfer PEWS scoring, there was no significant reduction in unplanned readmission frequency (10.2% vs 9.2%, P 5 .39). A secondary analysis of PEWS scores revealed cardiac scoring as a strong discriminator of those likely to experience an unplanned readmission, independent of other significant clinical predictors of readmission (OR 1.78, 95% CI 1.17-2.71, P 5 .007). The resultant multivariate model was a good predictor of unplanned readmission (AUC 0.77, 95% CI 0.71-0.83, P < .001).Conclusion: While implementation of a pretransfer PEWS assessment did not reduce the frequency of unplanned readmissions in this small single-center cohort, a multivariate model including pretransfer elements of an early warning scoring system, along with other patient characteristics serves as a good discriminator of patients likely to experience an unplanned readmission following CICU discharge. Further prospective investigation is needed to define objective measures of pretransfer discharge readiness to potentially reduce the likelihood of unplanned readmissions.

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“…In both studies, higher PEWS were associated with an increased risk of readmission; however, implementing a pretransfer PEWS assessment did not significantly reduce readmissions to the cardiac PICU 19. For the general PICU, analysis of the retrospective data indicated that implementation would overwhelm the resources available due to delayed discharges and inappropriate readmission 18. Both studies indicate that PEWS alone is unlikely to be an effective tool to identify and prevent readmissions to PICU and assessment needs to include other factors such as chronic disease variables.…”

Section: Where Are They Used and How Do They Perform?mentioning

confidence: 90%

“…Two studies have examined the ability of PEWS to prevent readmission to the general18 and the cardiac PICU 19. In both studies, higher PEWS were associated with an increased risk of readmission; however, implementing a pretransfer PEWS assessment did not significantly reduce readmissions to the cardiac PICU 19.…”

Section: Where Are They Used and How Do They Perform?mentioning

confidence: 99%

Early warning scores in paediatrics: an overview

Chapman

Maconochie

2018

Arch Dis Child

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Paediatric Early Warning Scores (PEWS)are used in hospitalised patients to detect physiological deterioration and is being used increasingly throughout healthcare systems with a limited evidence based. There are two versions in general use that can lead to a clinical response, either by triggering an action or by reaching a ‘threshold’ when graduated responses may occur depending on the value of the score. Most evidence has come from research based on paediatric inpatients in specialist children’s hospitals, although the range of research is expanding, taking into account other clinical areas such as paediatric intensive care unit, emergency department and the prehospital setting. Currrently, it is uncertain whether a unified system does deliver benefits in terms of outcomes or financial savings, but it may inform and improve patient communication. PEWS may be an additional tool in context of a patient’s specific condition, and future work will include its validation for different conditions, different clinical settings, patient populations and organisational structure. The incorporation of PEWS within the electronic health records may form a keystone of the safe system framework and allow the development of consistent PEWS system to standardise practice.

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Pediatric Early Warning Score and unplanned readmission to the pediatric intensive care unit

Cited by 41 publications

References 20 publications

Early warning systems and rapid response to the deteriorating patient in hospital: A systematic realist review

Early warning systems and rapid response to the deteriorating patient in hospital: A systematic realist review

Predicting unplanned readmissions to a pediatric cardiac intensive care unit using predischarge Pediatric Early Warning Scores

Early warning scores in paediatrics: an overview

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