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Pediatrics. 2013 Oct;132(4):e841-50. doi: 10.1542/peds.2012-3594. Epub 2013 Sep 9.

Validity of different pediatric early warning scores in the emergency department.

Author information

1
Department of Pediatrics, Room Sp 1540, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, PO Box 2060, 3000 CB Rotterdam, Netherlands. h.a.moll@erasmusmc.nl.

Abstract

OBJECTIVE:

Pediatric early warning scores (PEWS) are being advocated for use in the emergency department (ED). The goal of this study was to compare the validity of different PEWS in a pediatric ED.

METHODS:

Ten different PEWS were evaluated in a large prospective cohort. We included children aged <16 years who had presented to the ED of a university hospital in The Netherlands (2009-2012). The validity of the PEWS for predicting ICU admission or hospitalization was expressed by the area under the receiver operating characteristic (ROC) curves.

RESULTS:

These PEWS were validated in 17‚ÄČ943 children. Two percent of these children were admitted to the ICU, and 16% were hospitalized. The areas under the ROC curves for predicting ICU admission, ranging from 0.60 (95% confidence interval [CI]: 0.57-0.62) to 0.82 (95% CI: 0.79-0.85), were moderate to good. The area under the ROC curves for predicting hospitalization was poor to moderate (range: 0.56 [95% CI: 0.55-0.58] to 0.68 [95% CI: 0.66-0.69]). The sensitivity and specificity derived from the ROC curves ranged widely for both ICU admission (sensitivity: 61.3%-94.4%; specificity: 25.2%-86.7%) and hospital admission (sensitivity: 36.4%-85.7%; specificity: 27.1%-90.5%). None of the PEWS had a high sensitivity as well as a high specificity.

CONCLUSIONS:

PEWS can be used to detect children presenting to the ED who are in need of an ICU admission. Scoring systems, wherein the parameters are summed to a numeric value, were better able to identify patients at risk than triggering systems, which need 1 positive parameter.

KEYWORDS:

child; emergency medical services; triage (early warning score); validity; vital signs

PMID:
24019413
DOI:
10.1542/peds.2012-3594
[Indexed for MEDLINE]
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