Development and initial validation of the Bedside Paediatric Early Warning System score

IntroductionAdverse outcomes following clinical deterioration in children admitted to hospital wards is frequently preventable. Identification of children for referral to critical care experts remains problematic. Our objective was to develop and validate a simple bedside score to quantify severity of illness in hospitalized children.MethodsA case-control design was used to evaluate 11 candidate items and identify a pragmatic score for routine bedside use. Case-patients were urgently admitted to the intensive care unit (ICU). Control-patients had no 'code blue', ICU admission or care restrictions. Validation was performed using two prospectively collected datasets.ResultsData from 60 case and 120 control-patients was obtained. Four out of eleven candidate-items were removed. The seven-item Bedside Paediatric Early Warning System (PEWS) score ranges from 0–26. The mean maximum scores were 10.1 in case-patients and 3.4 in control-patients. The area under the receiver operating characteristics curve was 0.91, compared with 0.84 for the retrospective nurse-rating of patient risk for near or actual cardiopulmonary arrest. At a score of 8 the sensitivity and specificity were 82% and 93%, respectively. The score increased over 24 hours preceding urgent paediatric intensive care unit (PICU) admission (P < 0.0001). In 436 urgent consultations, the Bedside PEWS score was higher in patients admitted to the ICU than patients who were not admitted (P < 0.0001).ConclusionsWe developed and performed the initial validation of the Bedside PEWS score. This 7-item score can quantify severity of illness in hospitalized children and identify critically ill children with at least one hours notice. Prospective validation in other populations is required before clinical application.

[1]  R. Brilli,et al.  Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit* , 2007, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[2]  D. E. Lawrence,et al.  APACHE—acute physiology and chronic health evaluation: a physiologically based classification system , 1981, Critical care medicine.

[3]  R. Berg,et al.  A prospective investigation into the epidemiology of in-hospital pediatric cardiopulmonary resuscitation using the international Utstein reporting style. , 2002, Pediatrics.

[4]  C. Tsang,et al.  Abdominal Aortic Aneurysm: A service in need of surgery? A report of the National Confidential Enquiry into Patient Outcome and Death , 2005 .

[5]  Alvan R. Feinstein,et al.  Principles of Medical Statistics , 2001 .

[6]  ASM Nawshad Uddin Ahmed,et al.  Clinical signs that predict severe illness in children under age 2 months: a multicentre study , 2008, The Lancet.

[7]  J. Ornato,et al.  First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. , 2006, JAMA.

[8]  D. Fraser,et al.  The PEWS score: potential calling criteria for critical care response teams in children's hospitals. , 2006, Journal of critical care.

[9]  Jane Marie Cioffi,et al.  Recognition of patients who require emergency assistance: a descriptive study. , 2000, Heart & lung : the journal of critical care.

[10]  C. Parshuram,et al.  A Cross-sectional Survey of Levels of Care and Response Mechanisms for Evolving Critical Illness in Hospitalized Children , 2007, Pediatrics.

[11]  T. Hodgetts,et al.  The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team. , 2002, Resuscitation.

[12]  Heather Duncan,et al.  The Pediatric Early Warning System score: a severity of illness score to predict urgent medical need in hospitalized children. , 2006, Journal of critical care.

[13]  K. Hillman,et al.  Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial , 2005, The Lancet.

[14]  C. Wren,et al.  Ambulatory blood pressure in schoolchildren , 1999, Archives of disease in childhood.

[15]  K. Hillman,et al.  The impact of introducing medical emergency team system on the documentations of vital signs. , 2009, Resuscitation.

[16]  U. Ruttimann,et al.  PRISM III: an updated Pediatric Risk of Mortality score. , 1996, Critical care medicine.

[17]  Paul J Sharek,et al.  Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a Children's Hospital. , 2007, JAMA.

[18]  A. Feinstein.  Evaluating “Conformity” and Marker Tests , 2001 .

[19]  J. Tibballs,et al.  Reduction of paediatric in-patient cardiac arrest and death with a medical emergency team: preliminary results , 2005, Archives of Disease in Childhood.

[20]  John B. Carlin,et al.  Clinical signs that predict severe illness in children underage 2 months: a multicentre study , 2008 .

[21]  M. Odell,et al.  An acute problem? A report of the National Confidential Enquiry into Patient Outcome and Death. , 2005, Nursing in critical care.

[22]  F. Shann,et al.  Should paediatric intensive care be centralised? Trent versus Victoria , 1997, The Lancet.

[23]  Saba Sarwar,et al.  National Confidential Enquiry into Patient Outcome and Death , 2007 .

[24]  Jane Marie Cioffi,et al.  Nurses' experiences of making decisions to call emergency assistance to their patients. , 2000, Journal of advanced nursing.

[25]  Marlene R. Miller,et al.  Transition from a traditional code team to a medical emergency team and categorization of cardiopulmonary arrests in a children's center. , 2008, Archives of pediatrics & adolescent medicine.

[26]  C. Macarthur,et al.  Development of a clinical asthma score for use in hospitalized children between 1 and 5 years of age. , 1996, Journal of clinical epidemiology.