The pediatric early warning system score: A severity of illness score to predict urgent medical need in hospitalized children☆☆☆
Abstract
Purpose
We developed and performed the initial retrospective validation of a pediatric severity of illness score. The score is to preemptively identify hospitalized children who are likely to require resuscitation to treat cardiopulmonary arrest.
Materials and Methods
The Pediatric Early Warning System (PEWS) score was developed using expert opinion. The score generated contained 20 items, 16 of which were able to be retrospectively abstracted. Validation used a case-control study design in a Canadian university–affiliated pediatric hospital. Eligible patients were younger than 18 years, were admitted to a hospital ward, and had no level-of-care restrictions. Case patients had a code blue called to obtain immediate assistance for treatment of impending or actual cardiopulmonary arrest. Control patients had no code blue event and were not urgently admitted to the intensive care unit within 48 hours of study. A total of 128 controls and 87 cases were compared.
Results
The PEWS score area under the receiver operating characteristic curve was 0.90. The sensitivity was 78% and the specificity was 95% at a score of 5.
Conclusions
Application of the score may have identified more than 3 quarters of code blue calls in our hospital with at least an hour's warning. After further refinement and validation, the PEWS score has great potential to increase the efficiency of care delivery and to improve the outcomes of care provided to hospitalized children.
Keywords: Early detection, Prevention, Code blue, Severity of illness
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☆ This work was supported by internal funding from the Department of Critical Care Medicine and the Research Institute at the Hospital for Sick Children, Toronto, Ontario, Canada. The investigators functioned independent of these funding sources, and have no conflict of interest to declare with respect to this publication. Drs C Parshuram and J Hutchison have received peer-reviewed funding from the Heart and Stroke Foundation of Canada to support ongoing research in the prevention and treatment of pediatric cardiopulmonary arrest. This funding was in part related to the work described in the submitted manuscript.
☆☆ H Duncan contributed to the concept, design, interpretation, and manuscript revisions. J Hutchison contributed to the design, interpretation, and manuscript revisions. CS Parshuram contributed to the concept, design, interpretation, and drafting of the manuscript and assisted with its revisions. All authors approved the final submitted manuscript.
PII: S0883-9441(06)00088-8
doi:10.1016/j.jcrc.2006.06.007
© 2006 Elsevier Inc. All rights reserved.
