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Open Access Highly Accessed Research

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 Parshuram123456789*, Heather P Duncan9, Ari R Joffe1011, Catherine A Farrell12, Jacques R Lacroix12, Kristen L Middaugh23, James S Hutchison1133467, David Wensley14, Nadeene Blanchard23, Joseph Beyene15162 and Patricia C Parkin2345

Author Affiliations

1 Department of Critical Care Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

2 Child Health Evaluative Sciences Program of The Research Institute, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

3 Centre for Safety Research, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

4 Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

5 Department of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada

6 Institute of Medical Science, 7213 Medical Sciences Building, 1 King's College Circle, University of Toronto, Toronto, ON, M5S 1A8, Canada

7 Interdepartmental Division of Critical Care Medicine, University of Toronto, 1 Kings College Circle, Toronto, ON, M5S 1A8, Canada

8 Centre for Patient Safety, University of Toronto, 525 University Avenue, Toronto, ON, M5G 1X8, Canada

9 Department of Paediatric Intensive Care, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK

10 Department of Pediatrics, University of Alberta, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada

11 Department of Pediatrics, Stollery Children's Hospital, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada

12 Department of Pediatrics, CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada

13 Neurosciences and Mental Health Program of The Research Institute, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

14 Department of Paediatrics, University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada

15 Program in Population Genomics, Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada

16 Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada

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Critical Care 2011, 15:R184  doi:10.1186/cc10337

Published: 3 August 2011

Abstract

Introduction

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.

Methods

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.

Results

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).

Conclusions

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.