title: 'The Score Matters': wide variations in predictive performance of 18 paediatric track and trigger systems.
abstract: To compare the predictive performance of 18 paediatric early warning systems (PEWS) in predicting critical deterioration.
  
  
  
  Retrospective case-controlled study. PEWS values were calculated from existing clinical data, and the area under the receiver operator characteristic curve (AUROC) compared.
  
  
  
  UK tertiary referral children's hospital.
  
  
  
  Patients without a 'do not attempt resuscitation' order admitted between 1 January 2011 and 31 December 2012. All patients on paediatric wards who suffered a critical deterioration event were designated 'cases' and matched with a control closest in age who was present on the same ward at the same time.
  
  
  
  Respiratory and/or cardiac arrest, unplanned transfer to paediatric intensive care and/or unexpected death.
  
  
  
  12 'scoring' and 6 'trigger' systems were suitable for comparative analysis. 297 case events in 224 patients were available for analysis. 244 control patients were identified for the 311 events. Three PEWS demonstrated better overall predictive performance with an AUROC of 0.87 or greater. Comparing each system with the highest performing PEWS with Bonferroni's correction for multiple comparisons resulted in statistically significant differences for 13 systems. Trigger systems performed worse than scoring systems, occupying the six lowest places in the AUROC rankings.
  
  
  
  There is considerable variation in the performance of published PEWS, and as such the choice of PEWS has the potential to be clinically important. Trigger-based systems performed poorly overall, but it remains unclear what factors determine optimum performance. More complex systems did not necessarily demonstrate improved performance.
authors.affiliation: Great Ormond Street Hospital, London, UK.|UCL Great Ormond Street Institute of Child Health, London, UK.|Department of Children's Nursing, London South Bank University, London, UK.
authors.forename: Susan M
authors.identifier: 0000-0003-0778-084X
authors.initials: SM
authors.lastname: Chapman
authors.affiliation: UCL Great Ormond Street Institute of Child Health, London, UK.|Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital, London, UK.
authors.forename: Jo
authors.initials: J
authors.lastname: Wray
authors.affiliation: UCL Great Ormond Street Institute of Child Health, London, UK.|Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital, London, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Oulton
authors.affiliation: Clinical Operational Research Unit, University College London, London, UK.|Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Pagel
authors.affiliation: Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK.|Respiratory, Anaesthesia, and Critical Care Group, UCL Great Ormond Street Institute of Child Health, London, UK.
authors.forename: Samiran
authors.identifier: 0000-0002-3738-4672
authors.initials: S
authors.lastname: Ray
authors.affiliation: Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK.|Respiratory, Anaesthesia, and Critical Care Group, UCL Great Ormond Street Institute of Child Health, London, UK.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Peters
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D018450:Disease Progression; D005260:Female; D006760:Hospitalization; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008131:London; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index
keywords: Intensive Care; Monitoring; Resuscitation