Abstract |
Background: PEWS (Pediatric Early Warning Systems) are standardized systems of stratification of patients at risk of deterioration, through recording and quantifying changes in vital signs into a numerical score. They can be used on inpatient and pre-hospital settings for the timely and appropriate response to deterioration of pediatric patients. There is a significant heterogeneity in the available PEWS as well as the data regarding their ability to predict deterioration or improve outcomes.
Objective: To evaluate the effectiveness of PEWS scale for the timely recognition of deterioration on hospitalized pediatric patient and the appropriate clinical intervention. To evaluate a possible correlation of PEWS with PICU admission or transfer to a higher-level center.
Methods: This is a prospective single-center observation study on patients aged 29 days-16 years who were admitted from the ED in the Pediatric department of Venizelion General Hospital of Heraclion between July and December 2022. Successive PEWS-time values were recorded from the arrival at the ED (PEWS-0) and afterwards every 8 hours (PEWS-8, 16 etc.) for the first 48 hours of admission. In addition, basic epidemiological, clinical, laboratory and imaging features, clinical deterioration and corresponding intervention at the respective PEWS-time, and outcome. Depending on outcome, patients were put into a “discharge” group for those that improved and were discharged and a “transfer” group for those who were transferred to PICU or a higher-level-of-care center. A comparison of PEWS value tendencies was performed between the two groups as well as ROC analysis. A further comparison of PEWS-time values between patients-times where clinical deterioration in need of urgent intervention was recorded and those where no deterioration was noted. NHS Scotland PEWS charts, 2nd edition (CC BY-SA 4.0) were used for the calculation and recording of PEWS values.
Results: A total of 240 patients were included in the study. 210 (87,5%) improved and were discharged while 30 (12,5%) were transferred to higher-level-of-care centers, including 7 (2,9%) to PICU. All PEWS-time calculations from time 0h to time 48h demonstrated exceptional ability to predict patient deterioration and the necessity for intervention, with a gradually declining AUROC value (0,93 (95%CI 0,88-0,97), p<0,001, 0h, till 0,64 (95%CI 0,55-0,74), p=0,003, time 48h). Significant predictive ability was recorded for emergency PICU admission or next-level-of-care transfer with higher values noted on time 24h (AUROC 0,92 (95%CI 0,86-0,98), p=0,001) and 32h (AUROC 0,89 (95%CI 0,81-0,97), p=0,001). The “discharge” group had gradually declining PEWS values over time in contrast with the “transfer” group where PEWS values were steadily higher, especially on time 8h (p<0.001) 24h (p=0.006), 32h (p=0.01) and 48h (p=0.004) since admission.
Conclusion: PEWS Scotland demonstrated a significant correlation with patient deterioration as well as PICU admission. PEWS can be used on inpatient pediatric population for timely alert of healthcare personnel to intervene when deterioration as well as aid to the decision for PICU admission/higher-level-of-care transfer.
|