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. 2017 Mar 13;7(3):e014497.
doi: 10.1136/bmjopen-2016-014497.

Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review

Veronica Lambert  1 , Anne Matthews  1 , Rachel MacDonell  2 , John Fitzsimons  3
Affiliations

Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review

Veronica Lambert et al. BMJ Open. .

Abstract

Objective: To systematically review the available evidence on paediatric early warning systems (PEWS) for use in acute paediatric healthcare settings for the detection of, and timely response to, clinical deterioration in children.

Method: The electronic databases PubMed, MEDLINE, CINAHL, EMBASE and Cochrane were searched systematically from inception up to August 2016. Eligible studies had to refer to PEWS, inclusive of rapid response systems and teams. Outcomes had to be specific to the identification of and/or response to clinical deterioration in children (including neonates) in paediatric hospital settings (including emergency departments). 2 review authors independently completed the screening and selection process, the quality appraisal of the retrieved evidence and data extraction; with a third reviewer resolving any discrepancies, as required. Results were narratively synthesised.

Results: From a total screening of 2742 papers, 90 papers, of varied designs, were identified as eligible for inclusion in the review. Findings revealed that PEWS are extensively used internationally in paediatric inpatient hospital settings. However, robust empirical evidence on which PEWS is most effective was limited. The studies examined did however highlight some evidence of positive directional trends in improving clinical and process-based outcomes for clinically deteriorating children. Favourable outcomes were also identified for enhanced multidisciplinary team work, communication and confidence in recognising, reporting and making decisions about child clinical deterioration.

Conclusions: Despite many studies reporting on the complexity and multifaceted nature of PEWS, no evidence was sourced which examined PEWS as a complex healthcare intervention. Future research needs to investigate PEWS as a complex multifaceted sociotechnical system that is embedded in a wider safety culture influenced by many organisational and human factors. PEWS should be embraced as a part of a larger multifaceted safety framework that will develop and grow over time with strong governance and leadership, targeted training, ongoing support and continuous improvement.

Keywords: PEWS; Paediatric early warning system; children; clinical deterioration; systematic review.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart of search strategy output and screening process.
Figure 2
Figure 2
Diagnostic predictive accuracy of paediatric early warning detection systems.
See this image and copyright information in PMC

References

    1. Confidential Enquiry into Maternal and Child Health (CEMACH). Why children die—a pilot study 2006. London: CEMACH, 2008.
    1. Robson MA, Cooper CL, Medicus LA et al. . Comparison of three acute care pediatric early warning scoring tools. J Pediatr Nurs 2013;28:e33–41. 10.1016/j.pedn.2012.12.002 - DOI - PubMed
    1. McLellan MC, Gauvreau K, Connor JA. Validation of the cardiac children's hospital early warning score: an early warning scoring tool to prevent cardiopulmonary arrests in children with heart disease. Congenit Heart Dis 2014;9:194–202. 10.1111/chd.12132 - DOI - PubMed
    1. Endacott R, Kidd T, Chaboyer W et al. . Recognition and communication of patient deterioration in a regional hospital: a multi-methods study. Aust Crit Care 2007;20:100–5. 10.1016/j.aucc.2007.05.002 - DOI - PubMed
    1. Van Leuvan C, Mitchell I. Missed opportunities? An observational study of vital sign measurements. Crit Care Resusc 2008;10:111–5. - PubMed

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