Division of General Pediatrics of Pediatrics, Boston Children's Hospital, Boston, MA.
Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Clin Pediatr (Phila). 2024 Jan;63(1):126-134. doi: 10.1177/00099228231166264. Epub 2023 Apr 10.
The pediatric early warning score (PEWS) is a tool used to predict clinical deterioration. Referenced vital sign parameters are based on expert opinion but heart rate and respiratory rate percentiles in hospitalized children have been published. This retrospective case-control study of unplanned intensive care unit (ICU) transfers compares evidence-based vital signs (EBVS) effect on PEWS sensitivity and specificity, determines the impact of age categories on PEWS deterioration prediction, and evaluates whether EBVS PEWS is associated with need for invasive ICU supports. EBVS PEWS improved sensitivity (43%-71% vs 30%-63%) for unplanned transfers with slightly decreased specificity (88%-98% vs 93%-99%). Logistic regression analysis and odds ratios (ORs) demonstrated EBVS PEWS was associated with increased risk for ICU-specific supports (OR = 1.16, 95% confidence interval [CI] = 1.0-1.34, = .0498). Evidence-based vital signs can improve PEWS sensitivity to identify unplanned ICU transfers and identify patients requiring ICU-specific interventions.
儿科早期预警评分（PEWS）是一种用于预测临床恶化的工具。参考的生命体征参数基于专家意见，但已发表了住院儿童的心率和呼吸率百分位数。这项针对计划外重症监护病房（ICU）转科的回顾性病例对照研究比较了基于循证的生命体征（EBVS）对 PEWS 敏感性和特异性的影响，确定了年龄类别对 PEWS 恶化预测的影响，并评估了 EBVS PEWS 是否与需要侵入性 ICU 支持相关。EBVS PEWS 提高了计划外转科的敏感性（43%-71% 比 30%-63%），特异性略有下降（88%-98% 比 93%-99%）。逻辑回归分析和优势比（OR）表明，EBVS PEWS 与 ICU 特定支持的风险增加相关（OR = 1.16，95%置信区间 [CI] = 1.0-1.34，p =.0498）。基于循证的生命体征可以提高 PEWS 对识别计划外 ICU 转科的敏感性，并识别需要 ICU 特定干预的患者。
