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European Journal of Pediatrics

, Volume 178, Issue 2, pp 229–234 | Cite as

Recognizing critically ill children with a modified pediatric early warning score at the emergency department, a feasibility study

  • S. J. Vredebregt
  • H. A. Moll
  • F. J. Smit
  • J. J. VerhoevenEmail author
Original Article

Abstract

Pediatric Early Warning Scores were developed to monitor clinical deterioration of children admitted to the hospital. Pediatric Early Warning Scores could also be useful in the Emergency Department to quickly identify critically ill patients so treatment can be started without delay. To determine if a newly designed, fast, and easy to use Modified Pediatric Early Warning Score can identify critically ill children in the Emergency Department. We conducted a retrospective observational study in the Emergency Department of an urban district hospital in Rotterdam, the Netherlands. Patients < 16 years attending the Emergency Department with an internal medical problem were included. Immediate intensive care unit admission was used as a measure for critically ill children. During the study period 2980 children attended the Emergency Department, ten (0.4%) of them required immediate intensive care unit admission. The Modified Pediatric Early Warning Score can identify critically ill children in the general pediatric Emergency Department population (area under the ROC curve 0.82). A sensitivity of 80% and specificity of 85% show potential to rule out critical illness in children visiting the Emergency Department when these results are validated in a larger population. A model containing both the Modified Pediatric Early Warning Score and the Manchester Triage System did not perform significantly better than the Manchester Triage System alone but did show a positive tendency in favor of the model containing the Modified Pediatric Early Warning Score and Manchester Triage System, area under the ROC curve 0.89 [95% CI 0.77–1.00] versus area under the ROC curve 0.82 [95% CI 0.68–0.95].

Conclusions: In this feasibility study, the Modified Pediatric Early Warning Score could be a fast and easy to use tool to identify critically ill children in the general pediatric Emergency Department population. The effectiveness of the Modified Pediatric Early Warning Score may be optimized if combined with triage systems such as the Manchester Triage System. A larger prospective study is needed to confirm our results.

What is known:

• Pediatric Early Warning Scores can identify children who are in need for immediate intensive care unit admission at the Emergency Department.

• Pediatric Early Warning Scores can be time-consuming, contain subjective parameters or parameters which are difficult to obtain in a reliable and standardized method.

What is new:

• We introduce a simplified, manageable and smartly designed Pediatric Early Warning Score on a pocket card based on an existing and previously investigated Pediatric Early Warning Score.

• In this feasibility study the diagnostic performance of the Modified Pediatric Early Warning Score to predict immediate intensive care unit admission in the Emergency Department is in line with the original Pediatric Early Warning Scores but has to be validated on a larger scale.

Keywords

Pediatric early warning scores Triage Emergency department Referral and consultation Intensive care 

Abbreviations

ED

Emergency Department

ICU

Intensive care unit

MTS

Manchester Triage System

PEWS

Pediatric Early Warning Score

MPEWS

Modified Pediatric Early Warning Score

ROC

Receiver operating curve

Notes

Acknowledgments

We would like to thank the Maasstad Academy in person of Martijn Kuijper, statistician and epidemiologist, for providing suggestions in the manuscript review process.

Authors’ Contributions

S.J. Vredebregt has conceptualized and designed this study, carried out the analyses, and drafted the manuscript.

H.A. Moll has designed the initial study, supervised analyses, and reviewed and revised the manuscript.

F.J. Smit has supervised the data collection and reviewed and revised the manuscript.

J.J. Verhoeven has conceptualized and designed the study, designed the Modified Pediatric Early Warning Score, and reviewed and revised the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest

Financial disclosure

No relevant relationships to this article

Informed consent

This study was approved by the medical ethical committee of the Maasstad Hospital as part of a larger study, the requirement for informed consent was waived.

References

  1. 1.
    Duncan H, Hutchison J, Parshuram CS (2006) The pediatric early warning system score: a severity of illness score to predict urgent medical need in hospitalized children. J Crit Care 21(3):271–278.  https://doi.org/10.1016/j.jcrc.2006.06.007 CrossRefGoogle Scholar
  2. 2.
    Parshuram CS, Duncan HP, Joffe AR, Farrell CA, Lacroix JR, Middaugh KL, Hutchison JS, Wensley D, Blanchard N, Beyene J, Parkin PC (2011) Multicentre validation of the bedside paediatric early warning system score: a severity of illness score to detect evolving critical illness in hospitalised children. Crit Care 15(4):R184.  https://doi.org/10.1186/cc10337 CrossRefGoogle Scholar
  3. 3.
    Parshuram CS, Hutchison J, Middaugh K (2009) Development and initial validation of the bedside paediatric early warning system score. Crit Care 13(4):R135.  https://doi.org/10.1186/cc7998 CrossRefGoogle Scholar
  4. 4.
    Akre M, Finkelstein M, Erickson M, Liu M, Vanderbilt L, Billman G (2010) Sensitivity of the pediatric early warning score to identify patient deterioration. Pediatrics 125(4):e763–e769.  https://doi.org/10.1542/peds.2009-0338 CrossRefGoogle Scholar
  5. 5.
    Fuijkschot J, Vernhout B, Lemson J, Draaisma JM, Loeffen JL (2015) Validation of a paediatric early warning score: first results and implications of usage. Eur J Pediatr 174(1):15–21.  https://doi.org/10.1007/s00431-014-2357-8 CrossRefGoogle Scholar
  6. 6.
    Seiger N, Maconochie I, Oostenbrink R, Moll HA (2013) Validity of different pediatric early warning scores in the emergency department. Pediatrics 132(4):e841–e850.  https://doi.org/10.1542/peds.2012-3594 CrossRefGoogle Scholar
  7. 7.
    Bradman K, Maconochie I (2008) Can paediatric early warning score be used as a triage tool in paediatric accident and emergency? Eur J Emerg Med 15(6):359–360.  https://doi.org/10.1097/MEJ.0b013e3283026208 CrossRefGoogle Scholar
  8. 8.
    Lillitos PJ, Hadley G, Maconochie I (2016) Can paediatric early warning scores (PEWS) be used to guide the need for hospital admission and predict significant illness in children presenting to the emergency department? An assessment of PEWS diagnostic accuracy using sensitivity and specificity. Emerg Med J 33(5):329–337.  https://doi.org/10.1136/emermed-2014-204355 CrossRefGoogle Scholar
  9. 9.
    Jensen CS, Nielsen PB, Olesen HV, Kirkegaard H, Aagaard H (2018) Pediatric early warning score systems, Nurses Perspective - A Focus Group Study. J Pediatr Nurs 41:e16–e22.  https://doi.org/10.1016/j.pedn.2018.02.004 CrossRefGoogle Scholar
  10. 10.
    Sefton G, Lane S, Killen R, Black S, Lyon M, Ampah P, Sproule C, Loren-Gosling D, Richards C, Spinty J, Holloway C, Davies C, Wilson A, Chean CS, Carter B, Carrol ED (2017) Accuracy and efficiency of recording pediatric early warning scores using an electronic physiological surveillance system compared with traditional paper-based documentation. Comput Inform Nurs 35(5):228–236.  https://doi.org/10.1097/CIN.0000000000000305 CrossRefGoogle Scholar
  11. 11.
    Breslin K, Marx J, Hoffman H, McBeth R, Pavuluri P (2014) Pediatric early warning score at time of emergency department disposition is associated with level of care. Pediatr Emerg Care 30(2):97–103.  https://doi.org/10.1097/PEC.0000000000000063 CrossRefGoogle Scholar
  12. 12.
    Niu X, Tilford B, Duffy E, Kobayashi H, Ryan K, Johnson M, Page B, Martin C, Caldwell R, Mahajan P (2016) Feasibility and reliability of pediatric early warning score in the emergency department. J Nurs Care Qual 31(2):161–166.  https://doi.org/10.1097/NCQ.0000000000000162 CrossRefGoogle Scholar
  13. 13.
    Egdell P, Finlay L, Pedley DK (2008) The PAWS score: validation of an early warning scoring system for the initial assessment of children in the emergency department. Emerg Med J 25(11):745–749.  https://doi.org/10.1136/emj.2007.054965 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PediatricsMaasstad HospitalRotterdamThe Netherlands
  2. 2.Department of PediatricsErasmus MC-Sophia Children’s HospitalRotterdamThe Netherlands

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