Abstract
Background Pediatric Early Warning Scores (PEWS) for hospital inpatients can recognise deteriorating children hours before a critical event. We have previously published data validating the use of PEWS in the out-of-hospital environment.
Study Objectives 1. Which specific physiological parameters of the PEWS were most predictive of the primary outcome; specifically, ICU admission within 48 hours or death within 30 days2. Is a quick PEWS (qPEWS), using less parameters, valid in the out-of-hospital environment.
Methods All patients aged < 16 years old conveyed by the Scottish Ambulance Service (SAS) to hospital from 2011 to 2015. A stepwise approach was used by including the eight individual PEWS components with significance level thresholds of 5% and 10% respectively for entry to and remaining in the model.
Results 102,993 patients were available for analysis. All eight components of the PEWS were independent predictors of the primary outcome; however, the AUC increased little after the first 4 entered components - GCS, heart rate, O2 saturation and systolic BP - derived as the qPEWS. There were a total of 67265 patients with at least one record of all 4 components of a qPEWS score. Using the qPEWS score as the explanatory variable showed an area under the curve (AUC) for the primary outcome of 0.782 (95% CI 0.763 to 0.801, p<0.001). qPEWS using four components is predictive of adverse outcome in an unselected paediatric out-of-hospital population. Capture of the four data points required for qPEWS is much better - three times as many patients had the data available compared to PEWS (67265 vs 21202). All 4 of the parameters required for qPEWS can be captured with a saturation probe, making this a practical scoring tool to use in primary care, out-of-hospital and austere environments. This simplified score is not at the expense of diagnostic accuracy.
Study Objectives 1. Which specific physiological parameters of the PEWS were most predictive of the primary outcome; specifically, ICU admission within 48 hours or death within 30 days2. Is a quick PEWS (qPEWS), using less parameters, valid in the out-of-hospital environment.
Methods All patients aged < 16 years old conveyed by the Scottish Ambulance Service (SAS) to hospital from 2011 to 2015. A stepwise approach was used by including the eight individual PEWS components with significance level thresholds of 5% and 10% respectively for entry to and remaining in the model.
Results 102,993 patients were available for analysis. All eight components of the PEWS were independent predictors of the primary outcome; however, the AUC increased little after the first 4 entered components - GCS, heart rate, O2 saturation and systolic BP - derived as the qPEWS. There were a total of 67265 patients with at least one record of all 4 components of a qPEWS score. Using the qPEWS score as the explanatory variable showed an area under the curve (AUC) for the primary outcome of 0.782 (95% CI 0.763 to 0.801, p<0.001). qPEWS using four components is predictive of adverse outcome in an unselected paediatric out-of-hospital population. Capture of the four data points required for qPEWS is much better - three times as many patients had the data available compared to PEWS (67265 vs 21202). All 4 of the parameters required for qPEWS can be captured with a saturation probe, making this a practical scoring tool to use in primary care, out-of-hospital and austere environments. This simplified score is not at the expense of diagnostic accuracy.
Original language | English |
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Article number | 133 |
Pages (from-to) | S53-S54 |
Number of pages | 2 |
Journal | Annals of Emergency Medicine |
Volume | 74 |
Issue number | 4 (Supplement) |
Early online date | 8 Oct 2019 |
DOIs | |
Publication status | Published - 31 Oct 2019 |
Event | American College of Emergency Physicians Research Forum - Colorado Convention Center, Denver, United States Duration: 27 Oct 2019 → 29 Oct 2019 Conference number: vol 74 no 4S https://www.acep.org/acep19/education/research-forum/ (Forum website.) |