title: A Pilot Study to Validate the Burn Center Pediatric Early Warning Score Tool in Clinical Practice.
abstract: The pediatric early warning score (PEWS) tool helps providers to detect subtle clinical deterioration in non-intensive care unit pediatric patients and intervene early to prevent significant adverse outcomes. Although widely used in general pediatrics, limited studies report on its validation; none report on use with burn-injured patients. New York-Presbyterian/Weill Cornell Medical Center modified a general PEWS system to a burn-specific PEWS and integrated its use into standard practice. This study investigated the external validity of the PEWS process in clinical practice. Fifty cases of patients aged 0 to 15.9 years admitted between January 2012 and June 2013, whose length of stay (LOS) more than 3 days were selected for review from this cohort of n equal to 187. Demographics, total PEWS and score changes, and compliance with PEWS documentation and with resultant interventions were reviewed. Continuous variables are presented as mean ± SD, P less than 0.05. Mean age, burn size, and LOS were 3.2 ± 3.3 years, 4.8 ± 5.7%, and 9.8 ± 7.0 days; 26% required grafting, and 50% were male. No mortalities occurred. One thousand six hundred and twelve PEWS from 1745 opportunities were documented (92.4%). For all PEWS (n = 1612) and PEWS greater than 0 (n = 912), means were 0.9 ± 1.2 and 1.6 ± 1.2, respectively. Among the 162 PEWS increase events, intake (54.1%) and output (4.5%) parameters increased most commonly. Of these, 129 PEWS increases (79.6%) were followed by an intervention that most commonly included text notation of score increase (93.7%), physician/physician assistant notification (70.5%), and feeding-tube insertion (25.6%). Patients with PEWS greater than 0 had similar age, LOS, and larger burn size (5.2% vs 1.4%, P < 0.05) than those with PEWS equal to 0. Compliance with PEWS performance and resultant actions based on score increases are high. Data support that even small changes in burn-injury specific PEWS stimulate provider discussion and intervention and support its validation; further studies on its effect on practice are warranted.
authors: From the *Weill Cornell Medical College in Qatar, Doha, Qatar; †New York-Presbyterian Hospital, New York, New York; and ‡Department of Surgery, Weill Cornell Medical College, New York, New York.
authors: Zahra H
authors: ZH
authors: Rahman
authors: Nicole E
authors: NE
authors: Leahy
authors: Kelly
authors: K
authors: Sessler
authors: Andrew
authors: A
authors: Greenway
authors: Logan
authors: L
authors: Sorensen
authors: Kara
authors: K
authors: Breznak
authors: Angela
authors: A
authors: Rabbitts
authors: Holly
authors: H
authors: Macklay
authors: Roger W
authors: RW
authors: Yurt
mesh_terms: D002053:Burn Units; D002056:Burns / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009518:New York; D010372:Pediatrics; D010865:Pilot Projects; D012189:Retrospective Studies