McLellan Mary C, Gauvreau Kimberlee, Connor Jean A
Cardiovascular Program Inpatient Unit, Boston Children's Hospital, Boston, Mass, USA.
Congenit Heart Dis. 2014 May-Jun;9(3):194-202. doi: 10.1111/chd.12132. Epub 2013 Aug 20.
Most inpatient pediatric arrests are preventable by early recognition/treatment of deterioration. Children with cardiac disease have the highest arrest rates; however, early warning scoring systems have not been validated in this population. The objective of this study was to validate the Cardiac Children's Hospital Early Warning Score (C-CHEWS) tool in inpatient pediatric cardiac patients. The associated escalation of care algorithm directs: routine care (score 0-2), increased assessment/intervention (3-4), or cardiac intensive care unit (CICU) consult/transfer (≥5).
Sensitivity and specificity were estimated based on retrospective review of patients that experienced unplanned CICU transfer/arrest (n = 64) and a comparison sample (n = 248) of admissions. The previously validated Pediatric Early Warning Score (PEWS) tool was used for comparison. Patients' highest C-CHEWS scores were compared with calculated PEWS scores. Area under the receiver operating characteristic (AUROC) curve was calculated for PEWS and C-CHEWS to measure discrimination.
The AUROC curve for C-CHEWS was 0.917 compared with PEWS 0.785 (P < .001). The algorithm AUROC curve was 0.902 vs. PEWS of 0.782. C-CHEWS algorithm sensitivity was 96.9 (score ≥ 2), 79.7 (≥4), and 67.2 (≥5) vs. PEWS of 81.1(≥2), 37.5 (≥4), and 23.4 (≥5). C-CHEWS specificity was 58.1 (≥2), 85.5 (≥4), and 93.6 (≥5) vs. PEWS of 81.1 (≥2), 94.8 (≥4) and 97.6 (≥5). Lead time of elevated C-CHEWS scores (≥2) was a median of 9.25 hours prior to event vs. PEWS, which was 2.25 hours and lead time for critical C-CHEWS scores (≥5) was 2 hours vs. 0 hours for PEWS (P < .001).
C-CHEWS has excellent discrimination to identify deterioration in children with cardiac disease and performed significantly better than PEWS both as an ordinal variable and when choosing cut points to maximize AUROC. C-CHEWS has a higher sensitivity than PEWS at all cut points.
大多数儿科住院患者的心搏骤停可通过早期识别/治疗病情恶化来预防。患有心脏病的儿童心搏骤停率最高；然而，早期预警评分系统尚未在这一人群中得到验证。本研究的目的是在儿科心脏病住院患者中验证儿童医院心脏早期预警评分（C-CHEWS）工具。相关的护理升级算法指导：常规护理（评分0-2）、增加评估/干预（3-4）或心脏重症监护病房（CICU）会诊/转诊（≥5）。
基于对经历计划外CICU转诊/心搏骤停的患者（n = 64）和对照样本（n = 248）入院情况的回顾性分析，估计敏感性和特异性。使用先前验证的儿科早期预警评分（PEWS）工具进行比较。比较患者的最高C-CHEWS评分与计算得出的PEWS评分。计算PEWS和C-CHEWS的受试者工作特征曲线下面积（AUROC）以衡量辨别力。
C-CHEWS的AUROC曲线为0.917，而PEWS为0.785（P <.001）。算法AUROC曲线为0.902，而PEWS为0.782。C-CHEWS算法的敏感性在评分≥2时为96.9，≥4时为79.7，≥5时为67.2，而PEWS在≥2时为81.1，≥4时为37.5，≥5时为23.4。C-CHEWS的特异性在≥2时为58.1，≥4时为85.5，≥5时为93.6，而PEWS在≥2时为81.1，≥4时为94.8，≥5时为97.6。C-CHEWS评分升高（≥2）的提前期在事件发生前中位数为9.25小时，而PEWS为2.25小时，关键C-CHEWS评分（≥5）的提前期为2小时，而PEWS为0小时（P <.001）。
C-CHEWS在识别心脏病患儿病情恶化方面具有出色的辨别力，在作为有序变量以及选择切点以最大化AUROC时，其表现均明显优于PEWS。在所有切点处，C-CHEWS的敏感性均高于PEWS。
