Sambeeck Sam J van, Fuijkschot Joris, Kramer Boris W, Vos Gijs D
Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Pediatrics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
J Pediatr Intensive Care. 2018 Mar;7(1):27-32. doi: 10.1055/s-0037-1602802. Epub 2017 May 3.
The objective was to evaluate the use of a pediatric early warning system (PEWS) score in Dutch general and university hospitals, 4 years after the introduction of a national safety program in which the implementation of a PEWS was advised. An electronic cross-sectional survey was used. All general and university hospitals ( = 91) with a pediatric department in The Netherlands were included in the study. The response rate was 100%. Three-quarters of all Dutch hospitals were using a PEWS score in the pediatric department. A wide variation in the parameters was found leading to 45 different PEWS scores. Almost all PEWS scores were invalidated, self-designed, or modified from other PEWS scores. In one-third of the hospitals with an emergency room, a PEWS was used with a wide variation in the parameters leading to 20 different PEWS scores, the majority of which are invalidated. Three-quarters of the hospitals did implement a PEWS score. The majority implemented an invalidated PEWS score. This may lead to a false sense of security or even a potentially dangerous situation. Although these systems are intuitively experienced as useful, the scientific evidence in terms of hospital mortality reduction and patient safety improvement is lacking. It is recommended to establish a national working group to coordinate the development, validation, and implementation of a wide safety program and a PEWS usable for both general and university hospitals.
目的是在荷兰全国性安全计划推出4年后，评估荷兰综合医院和大学医院中儿科早期预警系统（PEWS）评分的使用情况，该计划建议实施PEWS。采用了电子横断面调查。荷兰所有设有儿科的综合医院和大学医院（n = 91）均纳入研究。回复率为100%。四分之三的荷兰医院在儿科使用PEWS评分。发现参数存在很大差异，导致出现45种不同的PEWS评分。几乎所有的PEWS评分都是无效的、自行设计的或从其他PEWS评分修改而来的。在三分之一设有急诊室的医院中，使用了PEWS，其参数差异很大，导致出现20种不同的PEWS评分，其中大多数是无效的。四分之三的医院确实实施了PEWS评分。大多数实施的是无效的PEWS评分。这可能会导致一种虚假的安全感，甚至可能造成危险情况。尽管这些系统在直观上被认为是有用的，但缺乏关于降低医院死亡率和改善患者安全方面的科学证据。建议成立一个国家工作组，以协调广泛的安全计划以及适用于综合医院和大学医院的PEWS的开发、验证和实施。
