Pediatric early warning score at time of emergency department disposition is associated with level of care.
OBJECTIVE
The objective of this study was to determine the association between the Pediatric Early Warning Score (PEWS) at time of emergency department (ED) disposition and level of care.


METHODS
We conducted a prospective observational study with a convenience sample of patients aged 0 to 21 years in the ED of an urban, tertiary care children's hospital between November 2010 and July 2011. Pediatric Early Warning Score data were obtained at time of ED disposition, and the disposition decision was collected from the electronic medical record. Multinomial logistic regression was used to determine the association between PEWS and disposition.


RESULTS
The sample of 383 patients included 239 (62%) who were discharged, 126 (33%) admitted to acute care, and 18 (5%) admitted to intensive care. Assigned scores ranged from 0 to 9. Adjusting for triage level, a 1-point increase in PEWS increased the odds of acute care admission 48% relative to the odds of discharge (odds ratio, 1.48; 95% confidence interval, 1.25-1.76) and increased the odds of intensive care admission 41% relative to the odds of acute care admission (odds ratio, 1.41; 95% confidence interval, 1.13-1.76). Pediatric Early Warning Score of 1 or more had maximum discriminant ability for admission, and PEWS of 3 or greater had maximum discriminant ability for intensive care. Area under the receiver operator characteristic curve was 0.68 to detect need for admission for the entire sample and 0.80 among the 97 patients with respiratory complaints.


CONCLUSIONS
Pediatric Early Warning Score is associated with the level of care at ED disposition but does not provide adequate sensitivity and specificity to be used in isolation. Performance characteristics are better for patients with respiratory complaints.
From the *Division of Emergency Medicine, Children's National Medical Center, Washington, DC; †Department of Pediatrics, Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ; ‡George Washington University School of Public Health and Health Services, Washington, DC; §Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY; and ∥Division of Hospitalist Medicine, Children's National Medical Center, Washington, DC.
Kristen
K
Breslin
Julie
J
Marx
Heather
H
Hoffman
Ryan
R
McBeth
Padmaja
P
Pavuluri
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D062072:Patient Acuity; D005791:Patient Care; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D055815:Young Adult