Edwards E D, Powell C V E, Mason B W, Oliver A
Department of Paediatrics, Singleton Hospital, Swansea SA2 8QA, UK.
Arch Dis Child. 2009 Aug;94(8):602-6. doi: 10.1136/adc.2008.142026. Epub 2008 Sep 23.
To develop and test the predictability of a paediatric early warning score to identify children at risk of developing critical illness.
Prospective cohort study.
Admissions to all paediatric wards at the University Hospital of Wales.
Respiratory arrest, cardiac arrest, paediatric high-dependency unit admission, paediatric intensive care unit admission and death.
Data were collected on 1000 patients. A single abnormal observation determined by the Cardiff and Vale paediatric early warning system (C&VPEWS) had a 89.0% sensitivity (95% CI 80.5 to 94.1), 63.9% specificity (95% CI 63.8 to 63.9), 2.2% positive predictive value (95% CI 2.0 to 2.3) and a 99.8% negative predictive value (95% CI 99.7 to 99.9) for identifying children who subsequently had an adverse outcome. The area under the receiver operating characteristic curve for the C&VPEWS score was 0.86 (95% CI 0.82 to 0.91).
Identifying children likely to develop critical illness can be difficult. The assessment tool developed from the advanced paediatric life support guidelines on identifying sick children appears to be sensitive but not specific. If the C&VPEWS was used as a trigger to activate a rapid response team to assess the child, the majority of calls would be unnecessary.
开发并测试一种儿科早期预警评分，以识别有发生危重症风险的儿童。
前瞻性队列研究。
威尔士大学医院所有儿科病房的入院情况。
呼吸骤停、心脏骤停、儿科高依赖病房入院、儿科重症监护病房入院及死亡。
收集了1000例患者的数据。由加的夫和韦尔儿科早期预警系统（C&VPEWS）确定的单个异常观察结果，对于识别随后出现不良结局的儿童，灵敏度为89.0%（95%可信区间80.5至94.1），特异度为63.9%（95%可信区间63.8至63.9），阳性预测值为2.2%（95%可信区间2.0至2.3），阴性预测值为99.8%（95%可信区间99.7至99.9）。C&VPEWS评分的受试者工作特征曲线下面积为0.86（95%可信区间0.82至0.91）。
识别可能发生危重症的儿童可能具有挑战性。根据高级儿科生命支持指南制定的用于识别患病儿童的评估工具似乎灵敏度高但特异度低。如果将C&VPEWS用作触发快速反应团队评估儿童的指标，那么大多数呼叫将是不必要的。
