Validation of the Children's Hospital Early Warning System for Critical Deterioration Recognition.
OBJECTIVE
Early warning scores, such as the Children's Hospital Early Warning Score (CHEWS), are used by hospitals to identify patients at risk for critical deterioration and trigger clinicians to intervene and prevent further deterioration. This study's objectives were to validate the CHEWS and to compare the CHEWS to the previously validated Brighton Pediatric Early Warning Score (PEWS) for early detection of critical deterioration in hospitalized, non-cardiac patients at a pediatric hospital.


METHODS
A retrospective cohort study reviewed medical and surgical patients at a quaternary academic pediatric hospital. CHEWS scores and abstracted PEWS scores were obtained on cases (n=360) and a randomly selected comparison sample (n=776). Specificity, sensitivity, area under the receiver-operating characteristic curves (AUROC) and early warning times were calculated for both scoring tools.


RESULTS
The AUROC for CHEWS was 0.902 compared to 0.798 for PEWS (p<0.001). Sensitivity for scores ≥3 was 91.4% for CHEWS and 73.6% for PEWS with specificity of 67.8% for CHEWS and 88.5% for PEWS. Sensitivity for scores ≥5 was 75.6% for CHEWS and 38.9% for PEWS with specificity of 88.5% for CHEWS and 93.9% for PEWS. The early warning time from critical score (≥5) to critical deterioration was 3.8h for CHEWS versus 0.6h for PEWS (p<0.001).


CONCLUSIONS
The CHEWS system demonstrated higher discrimination, higher sensitivity and longer early warning time than the PEWS for identifying children at risk for critical deterioration.
Boston Children's Hospital, Boston, MA, United States. Electronic address: mary.mclellan@childrens.harvard.edu.
Mary C
MC
McLellan
Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States. Electronic address: kimberlee.gauvreau@cardio.chboston.org.
Kimberlee
K
Gauvreau
Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States. Electronic address: jean.connor@childrens.harvard.edu.
Jean Anne
JA
Connor
D000465:Algorithms; D002648:Child; D015331:Cohort Studies; D003422:Critical Care / Q000592:standards*; D016638:Critical Illness / Q000451:nursing*; D019091:Critical Pathways / Q000592:standards*; D042241:Early Diagnosis; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014218:Triage / Q000379:methods*
Cardiopulmonary arrest; Critical deterioration; Early warning score; Patient safety; Pediatric; Rapid response team