Jensen Claus Sixtus, Olesen Hanne Vebert, Aagaard Hanne, Svendsen Marie Louise Overgaard, Kirkegaard Hans
Research Centre for Emergency Medicine, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark; Department of Paediatrics and Adolescent Medicine, Herlev Gentofte University Hospital, Herlev, Denmark.
Department of Child and Adolescent Health, Aarhus University Hospital, Aarhus N, Denmark.
J Pediatr Nurs. 2019 Jan-Feb;44:e58-e65. doi: 10.1016/j.pedn.2018.11.001. Epub 2018 Nov 22.
Pediatric early warning systems (PEWS) are used to detect clinical deterioration in hospitalized children. Few PEWSs have been validated in multicenter studies and the performance in many single-center studies varies. We wanted to compare two PEWS in a multicenter study.
Randomized multicenter unblinded trial conducted at all pediatric departments in the Central Denmark Region. A random sample of 16,213 pediatric patients (31,337 admissions) were enrolled from November 2014 to March 2017. Patients were randomized to The Bedside PEWS or CDR PEWS. The primary outcome was the sum of hospitalized children experiencing in-hospital clinical deterioration requiring transfer to a higher level of care.
Of the 21,077 pediatric patients who met the inclusion criteria, 16,213 (from 31,337 admissions) were enrolled. 22 unplanned transfers to a higher level of care were identified: 14 in The Bedside PEWS group and 8 in the CDR PEWS group, a non-statistical difference (P = 0.20). No significant difference in predicting unplanned transfer to a higher level of care (P = 0.78) were detected and no significant difference was observed in the secondary outcomes.
The CDR PEWS prevents as many critical events as The Bedside PEWS. Shorter median time to PEWS reassessment when CDR PEWS was used and fewer reassessments being done to late could reflect that the CDR PEWS was more acceptable to staff.
The results from this study should be interpreted with caution as very few patients experiencing clinical deterioration and further studies should also focus on challenges trying to evaluate PEWS.
儿科早期预警系统（PEWS）用于检测住院儿童的临床病情恶化情况。很少有PEWS在多中心研究中得到验证，并且许多单中心研究中的表现各不相同。我们希望在一项多中心研究中比较两种PEWS。
在丹麦中部地区的所有儿科科室进行随机多中心非盲试验。从2014年11月至2017年3月，随机抽取了16213名儿科患者（31337次入院）。患者被随机分配到床边PEWS或CDR PEWS。主要结局是经历需要转至更高护理级别的院内临床病情恶化的住院儿童总数。
在符合纳入标准的21077名儿科患者中，有16213名（来自31337次入院）被纳入研究。确定了22次非计划转至更高护理级别：床边PEWS组14次，CDR PEWS组8次，无统计学差异（P = 0.20）。在预测非计划转至更高护理级别方面未检测到显著差异（P = 0.78），次要结局也未观察到显著差异。
CDR PEWS预防的危急事件与床边PEWS一样多。使用CDR PEWS时，PEWS重新评估的中位时间更短，且较少出现重新评估过晚的情况，这可能表明CDR PEWS更易被工作人员接受。
本研究结果应谨慎解读，因为经历临床病情恶化的患者极少，进一步研究还应关注评估PEWS时面临的挑战。
