Use of paediatric early warning scores in intermediate care units

Abstract

Objective: Paediatric early warning scores (EWS) were developed to detect deterioration in paediatric wards or emergency departments. The aim of this study was to assess the relationship between three paediatric EWS and clinical deterioration detected by the nurse in paediatric intermediate care units (PImCU).

Methods: This was a prospective, observational, multicentre study at seven French regional hospitals that included all children <18 years of age. Clinical parameters included in three EWS (Paediatric Advanced Warning Score, Paediatric Early Warning Score and Bedside Paediatric Early Warning System) were prospectively recorded every 8 hours or in case of deterioration. The outcome was a call to physician by the nurse when a clinical deterioration was observed. The cohort was divided into derivation and validation cohorts. An updated methodology for repeated measures was used and discrimination was estimated by the area under the receiver-operating curve.

Results: A total of 2636 children were included for 14 708 observations to compute a posteriori the EWS. The discrimination of the three EWS for predicting calls to physicians by nurses was good (range: 0.87-0.91) for the derivation cohort and moderate (range: 0.71-0.76) for the validation cohort. Equations for probability thresholds of calls to physicians, taking into account the time t, the score at time t and the score at admission, are available.

Conclusion: These three EWS developed for children in paediatric wards or emergency departments can be used in PImCU to detect a clinical deterioration and predict the need for medical intervention.

Keywords: child; clinical deterioration; early warning score; intermediate care units; peformance.

Figure 1

Flow chart of the inclusions. *The distribution of patient inclusions in the seven centres were 369 for centre 1, 333 for centre 2, 477 for centre 3, 246 for centre 4, 272 for centre 5, 465 for centre 6 and 474 for centre 7.