The online version of this article (doi:10.1186/cc10337) contains supplementary material, which is available to authorized users.
CSP and KM are the named inventors of the Bedside Paediatric Early Warning System. US and European patents are pending. As of April 2011, CSP and KM owned stock in Bedside Clinical Systems, a Clinical Decision Support company. The activities of this company include development of an electronic form of the Bedside Paediatric Early Warning System, of which the Bedside PEWS score is a component.
CSP conceived of the study, contributed to its design, oversaw data acquisition, contributed to data analysis, wrote the initial draft of the manuscript and contributed to subsequent manuscript revisions. HPD, ARJ, CAF, JRL, KLM and JSH each contributed to the design of the study, contributed to data acquisition at their respective hospitals and contributed to manuscript revisions. PCP and DW contributed to the study design and manuscript revisions. JB contributed to the study design and analysis. NB contributed to study analysis and manuscript revisions. All authors read and approved the final manuscript.
The timely provision of critical care to hospitalised patients at risk for cardiopulmonary arrest is contingent upon identification and referral by frontline providers. Current approaches require improvement. In a single-centre study, we developed the Bedside Paediatric Early Warning System (Bedside PEWS) score to identify patients at risk. The objective of this study was to validate the Bedside PEWS score in a large patient population at multiple hospitals.
We performed an international, multicentre, case-control study of children admitted to hospital inpatient units with no limitations on care. Case patients had experienced a clinical deterioration event involving either an immediate call to a resuscitation team or urgent admission to a paediatric intensive care unit. Control patients had no events. The scores ranged from 0 to 26 and were assessed in the 24 hours prior to the clinical deterioration event. Score performance was assessed using the area under the receiver operating characteristic (AUCROC) curve by comparison with the retrospective rating of nurses and the temporal progression of scores in case patients.
A total of 2,074 patients were evaluated at 4 participating hospitals. The median (interquartile range) maximum Bedside PEWS scores for the 12 hours ending 1 hour before the clinical deterioration event were 8 (5 to 12) in case patients and 2 (1 to 4) in control patients (P < 0.0001). The AUCROC curve (95% confidence interval) was 0.87 (0.85 to 0.89). In case patients, mean scores were 5.3 at 20 to 24 hours and 8.4 at 0 to 4 hours before the event (P < 0.0001). The AUCROC curve (95% CI) of the retrospective nurse ratings was 0.83 (0.81 to 0.86). This was significantly lower than that of the Bedside PEWS score (P < 0.0001).
The Bedside PEWS score identified children at risk for cardiopulmonary arrest. Scores were elevated and continued to increase in the 24 hours before the clinical deterioration event. Prospective clinical evaluation is needed to determine whether this score will improve the quality of care and patient outcomes.
Leteurtre S, Martinot A, Duhamel A, Proulx F, Grandbastien B, Cotting J, Gottesman R, Joffe A, Pfenninger J, Hubert P, Lacroix J, Leclerc F: Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study. Lancet 2003, 362: 192-197. 10.1016/S0140-6736(03)13908-6 PubMedCrossRef
SAS Institute: Reciever Operating Characteristics Curve Macro.SAS Institute; Cary, NC; 2008. [ http://support.sas.com/kb/25/addl/fusion25017_5_roc.sas.txt]
Hunt EA, Zimmer KP, Rinke ML, Shilkofski NA, Matlin C, Garger C, Dickson C, Miller MR: Transition from a traditional code team to a medical emergency team and categorization of cardiopulmonary arrests in a children's center. Arch Pediatr Adolesc Med 2008, 162: 117-122. 10.1001/archpediatrics.2007.33 PubMedCrossRef
Slater A, Shann F, Pearson G: PIM2: a revised version of the Paediatric Index of Mortality. Intensive Care Med 2003, 29: 278-285. PubMed
Dryden-Palmer K: Nursing responses to children with evovling critical illness. In MS thesis. University of Victoria, School of Nursing; 2009.
Kause J, Smith G, Prytherch D, Parr M, Flabouris A, Hillman K: A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom: the ACADEMIA study. Resuscitation 2004, 62: 275-282. 10.1016/j.resuscitation.2004.05.016 PubMedCrossRef
- Multicentre validation of the bedside paediatric early warning system score: a severity of illness score to detect evolving critical illness in hospitalised children
Christopher S Parshuram
Heather P Duncan
Ari R Joffe
Catherine A Farrell
Jacques R Lacroix
Kristen L Middaugh
James S Hutchison
Patricia C Parkin
- BioMed Central
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
Mail Icon II