Chapman Susan M, Wray Jo, Oulton Kate, Pagel Christina, Ray Samiran, Peters Mark J
Great Ormond Street Hospital, London, UK.
UCL Great Ormond Street Institute of Child Health, London, UK.
Arch Dis Child. 2017 Jun;102(6):487-495. doi: 10.1136/archdischild-2016-311088. Epub 2017 Mar 14.
To compare the predictive performance of 18 paediatric early warning systems (PEWS) in predicting critical deterioration.
Retrospective case-controlled study. PEWS values were calculated from existing clinical data, and the area under the receiver operator characteristic curve (AUROC) compared.
UK tertiary referral children's hospital.
Patients without a 'do not attempt resuscitation' order admitted between 1 January 2011 and 31 December 2012. All patients on paediatric wards who suffered a critical deterioration event were designated 'cases' and matched with a control closest in age who was present on the same ward at the same time.
Respiratory and/or cardiac arrest, unplanned transfer to paediatric intensive care and/or unexpected death.
12 'scoring' and 6 'trigger' systems were suitable for comparative analysis. 297 case events in 224 patients were available for analysis. 244 control patients were identified for the 311 events. Three PEWS demonstrated better overall predictive performance with an AUROC of 0.87 or greater. Comparing each system with the highest performing PEWS with Bonferroni's correction for multiple comparisons resulted in statistically significant differences for 13 systems. Trigger systems performed worse than scoring systems, occupying the six lowest places in the AUROC rankings.
There is considerable variation in the performance of published PEWS, and as such the choice of PEWS has the potential to be clinically important. Trigger-based systems performed poorly overall, but it remains unclear what factors determine optimum performance. More complex systems did not necessarily demonstrate improved performance.
比较18种儿科早期预警系统（PEWS）在预测病情严重恶化方面的预测性能。
回顾性病例对照研究。根据现有临床数据计算PEWS值，并比较受试者工作特征曲线下面积（AUROC）。
英国三级转诊儿童医院。
2011年1月1日至2012年12月31日期间入院且无“不进行心肺复苏”医嘱的患者。儿科病房中所有发生病情严重恶化事件的患者被指定为“病例”，并与同时在同一病房的年龄最接近的对照患者进行匹配。
呼吸和/或心脏骤停、非计划转入儿科重症监护病房和/或意外死亡。
12种“评分”系统和6种“触发”系统适合进行比较分析。224例患者中的297例病例事件可供分析。为311例事件确定了244例对照患者。三种PEWS表现出更好的总体预测性能，AUROC为0.87或更高。将每个系统与表现最佳的PEWS进行比较，并采用Bonferroni法进行多重比较校正，结果显示13种系统存在统计学显著差异。“触发”系统的表现比“评分”系统差，在AUROC排名中占据最后六位。
已发表的PEWS在性能上存在很大差异，因此PEWS的选择可能具有重要的临床意义。基于“触发”的系统总体表现不佳，但尚不清楚哪些因素决定最佳性能。更复杂的系统不一定表现出更好的性能。
