Association of out of hospital paediatric early warning score with need for hospital admission in a Scottish emergency ambulance population

ObjectivePhysiological derangement, as measured by Paediatric Early Warning Score is used to identify children with critical illness at an early point to identify and intervene in children at risk. PEWS has shown some utility as a track and trigger system in hospital and also as a predictor of adverse outcome both in and out of hospital. This study examines the relationship between pre-hospital observations, aggregated into an eight point Paediatric Early Warning Score (PEWS Scotland), and hospital admission. 
MethodsA retrospective analysis of all patients aged <16 transported to hospital by the Scottish Ambulance Service between 2011 and 2015. Data were matched to outcome data regarding hospital admission or discharge, and length of stay. 
ResultsFull data were available for 21,202 paediatric patients, of whom 6,340 (29.9%) were admitted to hospital. Pre-hospital PEWS Scotland was associated with an odds ratio for admission of 1.189 (95%CI 1.176-1.202;p<0.001). The Area Under Receiver Operating Curve (AUROC) of 0.617 (95% CI 0.608-0.625; p<0.001), suggests poorly predictive ability for hospital admission. There was no association between pre-hospital PEWS Scotland and length of hospital stay. 

ConclusionThese data show that a single pre-hospital PEWS Scotland is a poor predictor of hospital admission for unselected patients in a pre-hospital population. The decision to admit a child to hospital is not solely based on physiological derangement of vital signs, and hence physiological based scoring systems such as PEWS Scotland cannot be used as the sole criteria for hospital admission, from an undifferentiated pre-hospital population.