title: Pediatric Early Warning Score and unplanned readmission to the pediatric intensive care unit.
abstract: OBJECTIVE
  Early unplanned Pediatric Intensive Care Unit (PICU) readmission is associated with greater length of stay and mortality. No tools exist to identify children at risk for PICU readmission. The Pediatric Early Warning Score (PEWS) currently identify children at risk for deterioration on the ward. Our primary objective was to evaluate the ability of PEWS to identify children at risk for unplanned PICU readmission.
  
  
  METHODS
  A single-center case-control study of 189 children (38 cases and 151 age-matched controls) 18years or younger transferred from the PICU to the pediatric ward from January 1, 2010-March 30, 2013, at an urban tertiary care children's hospital was conducted.
  
  
  RESULTS
  Thirty-eight cases had unplanned PICU readmission within 48hours of transfer to pediatric ward, whereas 151 controls were not readmitted. The PEWS assigned prior to PICU discharge and first PEWS assigned on the ward were collected for cases and controls. Each 1-point increase in the PEWS score significantly increased risk of PICU readmission (odds ratios [95% confidence intervals], 1.6 [1.12-2.27; P = .009] and 1.89 [1.33-2.69; P < .001], respectively). Discrimination ability of PEWS for PICU readmission improved when chronic diagnoses were included.
  
  
  CONCLUSIONS
  Higher PEWS scores were associated with increased risk of unplanned PICU readmission. However, cutoff scores are not sensitive or specific enough to be clinically useful. Adding chronic disease variables may improve the clinical utility of cutoff PEWS scores.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Iris M
authors.initials: IM
authors.lastname: Mandell
authors.affiliation: Department of Pediatrics, Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, CA; Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA.
authors.forename: Francine
authors.initials: F
authors.lastname: Bynum
authors.affiliation: Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Lori
authors.initials: L
authors.lastname: Marshall
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA; Department of Health Services, Los Angeles County, Los Angeles, CA; Departments of Pediatrics and Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, CA.
authors.forename: Robert
authors.initials: R
authors.lastname: Bart
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA; Departments of Pediatrics and Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, CA.
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Gold
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA; Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA. Electronic address: SarRubin@chla.usc.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Rubin
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D016022:Case-Control Studies; D002648:Child; D002908:Chronic Disease; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: PEWS; PICU readmission; Severity of illness