Comparison of Pediatric Early Warning Score to Physician Opinion for Deteriorating Patients.
BACKGROUND
This study compares a Pediatric Early Warning Score (PEWS) to physician opinion in identifying patients at risk for deterioration.


METHODS
Maximum PEWS recorded during each admission was retrospectively ascertained from electronic medical record data. Physician opinion regarding risk of subsequent deterioration was determined by assignment to an institutional "senior sign-out" (SSO) list that highlights patients whom senior pediatric residents have identified as at risk. Deterioration events were defined as intubation, initiation of high flow nasal cannula, inotropes, noninvasive mechanical ventilation, or aggressive fluid resuscitation within 12 hours of transfer to the PICU. We assessed the relationships of sociodemographic variables, PEWS, and SSO assignment with subsequent deterioration events using multivariate regression analysis to control for a number of covariates.


RESULTS
There were 97 patients with nonelective transfers to the PICU who were eligible for placement on the SSO lists before transfer, 51 of whom experienced qualifying deterioration events. Maximum recorded PEWS was significantly higher for patients with a subsequent deterioration event during the first 12 hours after transfer, compared with those who were transferred but did not experience a deterioration event in the first 12 hours (mean [SD]: 3.9 [2.0] vs 2.9 [2.0]; P = .01). This association persisted even after multivariate adjustment. SSO assignment was only marginally associated with risk of deterioration among this patient population, with or without adjustment for covariates.


CONCLUSIONS
The PEWS was significantly associated with ICU deterioration, whereas physician opinion was not. Used alone or in conjunction with physician assessment, PEWS is a valuable tool for identifying patients vulnerable to acute deterioration.
Children's National Health System, Washington, District of Columbia; and jb.fenix@gmail.com.
J B
JB
Fenix
Children's National Health System, Washington, District of Columbia; and George Washington School of Medicine, Washington, District of Columbia.
Catherine W
CW
Gillespie
Children's National Health System, Washington, District of Columbia; and George Washington School of Medicine, Washington, District of Columbia.
Amanda
A
Levin
Children's National Health System, Washington, District of Columbia; and George Washington School of Medicine, Washington, District of Columbia.
Nathan
N
Dean
D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards*; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011379:Prognosis; D012372:ROC Curve; D012107:Research Design / Q000592:standards*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D012720:Severity of Illness Index; D013997:Time Factors