Children's Hospitals and Clinics of Minnesota, Clinical Nursing Administration, 910 East 26th St, Suite 40-420, Minneapolis, MN 55403, USA.
Pediatrics. 2010 Apr;125(4):e763-9. doi: 10.1542/peds.2009-0338. Epub 2010 Mar 22.
We evaluated the Pediatric Early Warning Score (PEWS) sensitivity as an early indicator of patients deterioration leading to a Rapid Response Team (RRT)/code event. We hypothesized that at least 80% of patients had a critical PEWS preceding the event. We determined staff awareness of deterioration in patient status prior to the event as evidenced by consults, addition of monitoring equipment or increased frequency of assessment. The timing of these events was compared to critical PEWS times.
One hundred and seventy non-ICU RRT and 16 code events were identified between October 2006 and February 2008. We completed retrospective PEWS at four-hour intervals or less for twenty-four hours preceding the event. The PEWS algorithm, guiding staff to consult at a critical score > or =4 or a single domain score equal to 3, was applied.
For 85.5% of patients the earliest indicator of deterioration, evidenced by a critical PEWS, was a median of 11 hours 36 minutes and the earliest preceding the event was 30 minutes. For 97.1% of patients the earliest median time to a consult was 80 minutes. Oximetry was added 6.9 hours for 43.5% of patients. 7% of patients had increased nursing assessment. A sub-group of patients had 1) critical PEWS, 2) consult and 3) addition of a monitor. The median time for earliest critical PEWS for these was significant (P < 0.001).
PEWS can potentially provide a forewarning time >11 hours, alerting the team to adapt the care plan and possibly averting an RRT or code.
我们评估了儿科早期预警评分（PEWS）的敏感性，以作为导致快速反应团队（RRT）/代码事件的患者恶化的早期指标。我们假设，在事件发生之前，至少有 80%的患者的 PEWS 评分达到临界值。我们通过会诊、增加监测设备或增加评估频率来确定患者病情恶化之前医护人员的意识。这些事件的时间与临界 PEWS 时间进行了比较。
在 2006 年 10 月至 2008 年 2 月期间，我们确定了 170 例非 ICU 的 RRT 和 16 例代码事件。我们在事件发生前 24 小时内，每四小时或更短时间进行一次回顾性 PEWS。应用 PEWS 算法，指导医护人员在临界评分≥4 或单一域评分等于 3 时进行会诊。
对于 85.5%的患者，最早的恶化指标是临界 PEWS，中位数为 11 小时 36 分钟，最早的是在事件发生前 30 分钟。对于 97.1%的患者，最早的会诊中位数时间为 80 分钟。43.5%的患者的血氧饱和度监测时间延长了 6.9 小时。7%的患者增加了护理评估。一部分患者出现 1）临界 PEWS，2）会诊和 3）增加监测设备。这些患者的最早临界 PEWS 的中位数时间存在显著差异（P<0.001）。
PEWS 可以提供 >11 小时的预警时间，提醒团队调整护理计划，可能避免 RRT 或代码事件的发生。
