Emergency Department, Royal Alexandra Hospital, Paisley, PA2 9PN, United Kingdom.
Anaesthetic Department, Queen Elizabeth University Hospital, Glasgow, United Kingdom.
Resuscitation. 2018 Dec;133:153-159. doi: 10.1016/j.resuscitation.2018.10.010. Epub 2018 Oct 16.
Physiological deterioration often precedes clinical deterioration as patients develop critical illness. Use of a specific Paediatric Early Warning Score (PEWS), based on basic physiological measurements, may help identify children prior to their clinical deterioration. NHS Scotland has adopted a single national PEWS - PEWS (Scotland). We aim to look at the utility of PEWS (Scotland) in unselected paediatric ambulance patients.
We performed a retrospective cohort of all ambulance patients aged under 16 years conveyed to hospital in Scotland between 2011 and 2015. Patients were matched to their 30 day mortality and ICU admission using data linkage.
Full results were available for 21,202 children and young people (CYP). On multivariate logistic regression, PEWS (Scotland) was an independent predictor of the primary outcome (ICU admission within 48 h or death within 30 days) with an odds ratio of 1.403 (95%CI 1.349-1.460, p < 0.001). Area Under Receiving Operator Curve (AUROC) for aggregated PEWS was 0.797 (95% CI 0.759 to 0.836, p < 0.001). The optimal PEWS using Youlden's Index was 5.
These data show PEWS (Scotland) to be a useful tool in a pre-hospital setting. A single set of physiological observations undertaken prior to arrival at hospital can identify a group of children at higher risk of an adverse in-hospital outcome. Paediatric care is becoming more specialised and focussed on a smaller number of centres. In this context, use of PEWS (Scotland) in the pre-hospital phase may allow changes to paediatric pre-hospital pathways to improve both admission to ICU and child mortality rates.
患者发生危重病时，生理恶化通常先于临床恶化。使用基于基本生理测量的特定儿科早期预警评分（PEWS）可能有助于在临床恶化之前识别儿童。苏格兰国民保健系统采用了单一的国家 PEWS-PEWS（苏格兰）。我们旨在研究 PEWS（苏格兰）在未经选择的儿科救护车患者中的效用。
我们对 2011 年至 2015 年期间在苏格兰送往医院的所有年龄在 16 岁以下的救护车患者进行了回顾性队列研究。使用数据链接将患者与 30 天死亡率和 ICU 入院进行匹配。
共有 21202 名儿童和青少年（CYP）的完整结果可用。在多变量逻辑回归中，PEWS（苏格兰）是主要结局（48 小时内 ICU 入院或 30 天内死亡）的独立预测因子，优势比为 1.403（95%CI 1.349-1.460，p<0.001）。汇总 PEWS 的接受者操作特征曲线下面积（AUROC）为 0.797（95%CI 0.759-0.836，p<0.001）。使用 Youlden 指数的最佳 PEWS 为 5。
这些数据表明 PEWS（苏格兰）在院前环境中是一种有用的工具。在到达医院之前进行的一组单一的生理观察可以识别出一组发生不良院内结局风险较高的儿童。儿科护理越来越专业化，专注于少数几个中心。在这种情况下，在院前阶段使用 PEWS（苏格兰）可以改变儿科院前途径，以提高 ICU 入院率和儿童死亡率。
