Studnek Jonathan R, Browne Lorin R, Shah Manish I, Fumo Nicole, Hansen Matthew, Lerner E Brooke
Prehosp Emerg Care. 2020 May-Jun;24(3):341-348. doi: 10.1080/10903127.2019.1645924. Epub 2019 Sep 6.
The pediatric early warning score (PEWS) and the bedside pediatric early warning score (BPEWS) are validated tools that help determine the need for critical care in children with acute medical conditions. These tools could be used by EMS and have not been evaluated outside of the hospital. This study retrospectively tested the validity of these tools in the prehospital setting to identify children who needed a hospital with higher level pediatric resources. This was a multi-center retrospective validation of screening tools using prehospital and in-hospital data obtained from 3 EMS agencies. EMS patient records from April 1, 2013 to April 30, 2015 were used to identify subjects for this analysis. Pediatric patients were retrospectively classified using the PEWS based on the clinical information documented in the EMS medical record. Those with PEWS scores greater than 4 were matched to a subject with scores less than 4 based on age, gender, and paramedic primary impression. Hospital medical record review was then used to determine whether the patient required a hospital with higher level pediatric resources. These classifications were used to calculate sensitivity, specificity, and resultant 95% confidence intervals. The analysis was repeated for included subjects who had sufficient data to calculate BPEWS. There were 386 patients enrolled. A PEWS ≥ 4 demonstrated a sensitivity of 62.8 (95% CI 53.6-71.4) and a specificity of 55.9 (95% CI 49.6-61.9) in identifying a patient who required a hospital with higher level pediatric resources. There were 44 pairs of patients that had sufficient EMS data documented to calculate a BPEWS. A BPEWS ≥ 7 demonstrated a sensitivity of 46.4 (95% CI 27.5-66.1) and a specificity of 76.7 (95% CI 64.0-86.6) to correctly classify a patient who required a hospital with higher level pediatric resources. In the prehospital setting neither PEWS nor BPEWS exhibited sufficient sensitivity for clinical use to accurately identify children who need a hospital with higher level pediatric resources. Further research should be conducted to identify variables that are captured by prehospital care providers and are associated with children who need a hospital with higher level pediatric resources.
儿科早期预警评分（PEWS）和床边儿科早期预警评分（BPEWS）是经过验证的工具，有助于确定患有急性疾病的儿童是否需要重症监护。这些工具可供急救医疗服务（EMS）使用，且尚未在医院外进行评估。本研究回顾性地测试了这些工具在院前环境中的有效性，以识别那些需要具备更高级别儿科资源医院的儿童。这是一项多中心回顾性验证研究，使用从3个急救医疗服务机构获取的院前和院内数据对筛查工具进行验证。利用2013年4月1日至2015年4月30日的急救医疗服务患者记录来确定本次分析的研究对象。根据急救医疗服务病历中记录的临床信息，使用PEWS对儿科患者进行回顾性分类。将PEWS评分大于4的患者与年龄、性别和护理人员初步诊断相同但评分小于4的患者进行匹配。然后通过查阅医院病历，确定患者是否需要具备更高级别儿科资源的医院。这些分类用于计算敏感性、特异性以及由此得出的95%置信区间。对有足够数据来计算BPEWS的纳入研究对象重复进行上述分析。共有386名患者入组。在识别需要具备更高级别儿科资源医院的患者方面，PEWS≥4的敏感性为62.8（95%置信区间53.6 - 71.4），特异性为55.9（95%置信区间49.6 - 61.9）。有44对患者有足够的急救医疗服务数据来计算BPEWS。BPEWS≥7对正确分类需要具备更高级别儿科资源医院的患者的敏感性为46.4（95%置信区间27.5 - 66.1），特异性为76.7（95%置信区间64.0 - 86.6）。在院前环境中，PEWS和BPEWS在临床应用中均未表现出足够的敏感性来准确识别那些需要具备更高级别儿科资源医院的儿童。应开展进一步研究，以确定院前护理人员所掌握的、与需要具备更高级别儿科资源医院的儿童相关的变量。
