Abstract |
Background: Incidence of cardiopulmonary arrest in hospitalized children is extremely low
(0,7-3%), but mortality and morbidity remain high despite the progress of resuscitation
methods (11-37%). Research mainly conducted on the adult population has shown that during
the period before the arrest or other serious incidences, the physiological parameters
deteriorate. If these parameters were recognized earlier, the adverse events could have been
prevented. It has been estimated that approximately one in five children who die in hospital
has avoidable factors leading to death, and up to half of children have potentially avoidable
factors. In response to these epidemiological data, the pediatric early warning score (PEWS)
has been developed internationally to improve the safety of hospitalized children.
Objective: The purpose of the study is to evaluate the use of the PEWS score for the early
detection of children clinical deterioration and the appropriate modification of the patients'
treatment at a Pediatric department in a regional General Hospital in Crete.
Methods: This is a single-centre retrospective observational study including patients aged
from 30 days to 16 years old who were hospitalized at the pediatric clinic of Chania hospital
from July 2022 to December 2022. Patients' demographic data, imaging, laboratory findings,
and outcome were all recorded. Their PEWS scores were recorded three times per day for two
days.
Results: During the period of observation the PEWS score was calculated in 201 hospitalized
patients. Out of them, 190 were discharged home and 11 transported to an advanced Centre
(tertiary hospital) or to ICU. Most of the patients that needed to be transferred were
diagnosed with infection (81,8%), whilst among discharged patients’ infection was also the
dominant infection (77,4%) followed by accidents (7,4%). Comorbidity ranged at low levels
and was significantly higher in the transferred group (18,2%). The initial treatment was
characterized by fluid replacement and antibiotics at a high rate, especially in the transferred
group (90,9%) (p=0,010). The length of hospitalization was longer in the transferred group (3.7
vs. 3.3, p=0,018). The highest PEWS scores were noticed at the time of admission (PEWS 0).
Their distribution in the following calculations followed a deceleration rate (mean scores 3-
1,5-0,3) among discharged patients while it remained at the level of 2 from 8th to 48th hour
among transferred patients. In a ROC analysis, strong-predictive value ability of patients’
deterioration was shown in all calculated PEWS scores, with higher AUROC values at 40h.
Among different time -series, only the 48th-hour PEWS (AUROC 0,79 (95%CI 0,60-0,98),
p=0,006) and marginally the 24th-hour (AUROC 0,70 (95%CI 0,51-0,90), p=0,055) were able to
predict the need to transfer the patient to a tertiary Centre.
Conclusion: Despite the small number of participating patients, results of this study show that
the PEWS score detects clinical deterioration and the need for transfer to a tertiary Centre.
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