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. 2019 Feb 21;19(1):30.
doi: 10.1186/s12883-019-1247-0.

Establishment and utility assessment of posterior reversible encephalopathy syndrome early warning scoring (PEWS) scale establishment and utility assessment of PEWS scale

Li-Ping Zou  1   2 , Li-Ying Liu  3 , Hui Li  3 , Yang-Yang Wang  3 , Ying Liu  3 , Jing Chen  4 , Lin-Yan Hu  3 , Meng-Jia Liu  3 , Meng-Na Zhang  3 , Qian Lu  5 , Shu-Fang Ma  3
Affiliations

Establishment and utility assessment of posterior reversible encephalopathy syndrome early warning scoring (PEWS) scale establishment and utility assessment of PEWS scale

Li-Ping Zou et al. BMC Neurol. .

Abstract

Background: Posterior reversible encephalopathy syndrome (PRES) is a complication that occurs during various diseases' treatment. Imaging examination is the gold standard for diagnosis. PRES frequently occurrence in patients with hematological malignancies results in poorer prognosis and higher mortality. We aim to establish a practical and operable scale for early prediction, assessment of the severity of the Posterior Reversible Encephalopathy Syndrome, and timely intervention for better prognosis.

Methods: The scale designed by reviewing the literature and by referring to clinical practice. We assessed the reliability and validity of the scale. Scale-based assessment of children undergoing chemotherapy for acute lymphoblastic leukemia conducted as early warning and intervention for those who may have PRES.

Results: Establishment of Posterior Reversible Encephalopathy Syndrome early warning scoring (PEWS) scale included three parts, as follows: (1) risk factors, including underlying disease, hypertension, Infection, and drug toxicity; (2) clinical features, including high cranial pressure, visual symptoms, seizure, and disturbance of consciousness; and (3) EEG features, including slow wave and epileptiform discharges. Utility assessment of PEWS scale showed that in 57 patients with acute lymphoblastic leukemia, 54 scored less than 10 and none of them detected as PRES. The other two had scores of 12 and 13 both diagnosed with PRES by brain MRI scan.

Conclusions: PEWS scale can predict PRES early. PRES was highly suspected when the score was 10 points and more. Thus, prophylactic intervention can give to improve the prognosis of PRES.

Keywords: Electroencephalogram; Posterior reversible encephalopathy syndrome; Prevention; Scale; Seizure.

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Conflict of interest statement

Ethics approval and consent to participate

The research has approved by Chinese PLA General Hospital ethics committee, who permitted us to access patient’s data in all the cooperating hospitals. Informed written consent was obtained from patients’ parents, who gave their consent for their children’s information to be published in this manuscript.

Consent for publication

Written informed consent obtained from the patient’s parents for publication of this article and any accompanying Tables and Figures.

Competing interests

Foundation sponsors of the study played no role in the study design, data collection, data analysis, data interpretation, or writing of report. Authors have no competing interest in relation to the submission. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
PRES: Posterior reversible encephalopathy syndrome. No-PRES: Encephalitis. Two groups were compared. The median score for the PRES group was 15.5 (range 10–19), and the median score for the No-PRES (Encephalitis) group was 8 (range 6–12)
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curve of PEWS scale for patients. PEWS scale was able to detect PRES with a sensitivity of 94.1% and a specificity of 86.7%. Area under the curve (AUC) = 0.982, P = 0.000, 95%CI: 0.949–1.000
Fig. 3
Fig. 3
a female, five years old, EEG showed focal low amplitude slow wave, MRI was normal, PEWS 7. b female, five years old, EEG showed focal (right parietal and temporal lobe) epileptic discharge, MRI was normal, PEWS 10. c male, five years old, EEG showed slow wave background and epileptic discharge, MRI showed bilateral parieto-occipital subcortical white matter long T1 signal, long T2 signal, and equal DWI signal, PEWS 13. Abbreviations: EEG: electroencephalogram; MRI: magnetic resonance imaging; PEWS: posterior reversible encephalopathy syndrome early warning score
Fig. 4
Fig. 4
The flowchart of PRES early warning score scale
See this image and copyright information in PMC

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