Zachariasse Joany M, Espina Pinky Rose, Borensztajn Dorine M, Nieboer Daan, Maconochie Ian K, Steyerberg Ewout W, van der Lei Johan, Greber-Platzer Susanne, Moll Henriette A
Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
Division of Pediatric Pulmology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
Arch Dis Child. 2022 Mar;107(3):229-233. doi: 10.1136/archdischild-2021-322068. Epub 2021 Jul 21.
To assess the value of the Emergency Department-Pediatric Early Warning Score (ED-PEWS) for triage of children with comorbidity.
Secondary analysis of a prospective cohort.
53 829 consecutive ED visits of children <16 years in three European hospitals (Netherlands, UK and Austria) participating in the TrIAGE (Triage Improvements Across General Emergency departments) project in different periods (2012-2015).
ED-PEWS, a score consisting of age and six physiological parameters.
A three-category reference standard as proxy for true patient urgency. We assessed discrimination and calibration of the ED-PEWS for children with comorbidity (complex and non-complex) and without comorbidity. In addition, we evaluated the value of adding the ED-PEWS to the routinely used Manchester Triage System (MTS).
5053 (9%) children had underlying non-complex morbidity and 5537 (10%) had complex comorbidity. The c-statistic for identification of high-urgency patients was 0.86 (95% prediction interval 0.84-0.88) for children without comorbidity, 0.87 (0.82-0.92) for non-complex and 0.86 (0.84-0.88) for complex comorbidity. For high and intermediate urgency, the c-statistic was 0.63 (0.62-0.63), 0.63 (0.61-0.65) and 0.63 (0.55-0.73) respectively. Sensitivity was slightly higher for children with comorbidity (0.73-0.75 vs 0.70) at the cost of a lower specificity (0.86-0.87 vs 0.92). Calibration was largely similar. Adding the ED-PEWS to the MTS for children with comorbidity improved performance, except in the setting with few high-urgency patients.
The ED-PEWS has a similar performance in children with and without comorbidity. Adding the ED-PEWS to the MTS for children with comorbidity improves triage, except in the setting with few high-urgency patients.
评估急诊科儿童早期预警评分（ED-PEWS）对合并症患儿进行分诊的价值。
前瞻性队列的二次分析。
参与不同时期（2012 - 2015年）“TrIAGE（普通急诊科分诊改进）”项目的三家欧洲医院（荷兰、英国和奥地利）中16岁以下儿童连续53829次急诊就诊情况。
ED-PEWS，一种由年龄和六个生理参数组成的评分。
作为真实患者紧急程度替代指标的三类参考标准。我们评估了ED-PEWS对合并症（复杂和非复杂）患儿及无合并症患儿的区分能力和校准情况。此外，我们还评估了将ED-PEWS添加到常规使用的曼彻斯特分诊系统（MTS）中的价值。
5053名（9%）儿童有潜在的非复杂性合并症，5537名（10%）有复杂性合并症。无合并症患儿识别高紧急程度患者的c统计量为0.86（95%预测区间0.84 - 0.88），非复杂性合并症患儿为0.87（0.82 - 0.92），复杂性合并症患儿为0.86（0.84 - 0.88）。对于高紧急程度和中紧急程度，c统计量分别为0.63（0.62 - 0.63）、0.63（0.61 - 0.65）和0.63（0.55 - 0.73）。合并症患儿的敏感性略高（0.73 - 0.75对0.70），但特异性较低（0.86 - 0.87对0.92）。校准情况大致相似。对于合并症患儿，将ED-PEWS添加到MTS中可改善分诊表现，但在高紧急程度患者较少的情况下除外。
ED-PEWS在有合并症和无合并症的儿童中表现相似。对于合并症患儿，将ED-PEWS添加到MTS中可改善分诊，高紧急程度患者较少的情况除外。
