评估儿科早期预警评分预测住院儿童严重病情恶化事件的性能（DETECT研究）：一项回顾性匹配病例对照研究。

Assessing the performance of paediatric early warning scores to predict critical deterioration events in hospitalised children (the DETECT study): a retrospective matched case-control study.

作者信息

Bracken Abbey, Lane Steven, Siner Sarah, Jones Dawn, Lambert Caroline, Mehta Fulya, Eyton-Chong Chin-Kien, Davis Peter, Fitzsimons John, Lim Emma, Clerihew Linda, Carter Bernie, Sefton Gerri, Carrol Enitan D

机构信息

Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.

Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK.

出版信息

BMC Pediatr. 2025 Jul 2;25(1):520. doi: 10.1186/s12887-025-05754-x.

DOI:10.1186/s12887-025-05754-x

PMID:40604577

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12220617/

Abstract

BACKGROUND

Paediatric Early Warning Scores (PEWS) enhance patient safety, by focused monitoring of vital signs to identify children at risk of deteriorating. However, there is an acknowledged need for standardisation. The aim of this study was to compare the performance of seven PEWS (Alder Hey, Bedside, Bristol, Irish, Newcastle, Scottish and the proposed National PEWS for England (v3)) utilised in clinical practice in the United Kingdom and Ireland. The primary outcome was occurrence of a critical deterioration event (CDE) in hospitalised children, and secondary outcome was 72-hour hospital mortality.

METHODS

250 patient episodes were identified over a 12-month period. Cases were matched 2:1 with controls; using age range and admitting specialty. PEWS were calculated, along with performance characteristics. Maximum PEWS were calculated at 24, 12, 6 and 4 h prior to CDE or discharge, and area under the receiver operating curve (AUC) used to measure performance. Sub-group analysis explored performance within 3 specialities observed to have increased risk for deterioration. Kaplan-Meier survival curves compared time to event data using the identified optimum PEWS performance cut-point.

RESULTS

The median age of patients experiencing CDE was 8 months. AUCs across all PEWS in predicting CDE, ranged from 0·87 to 0·95. Optimum cut-offs for each PEWS were identified. Kaplan-Meier curves for cumulative risk of time to CDE according to the PEWS stratification, demonstrated CDE was significantly less likely for patients below the cut-off values (log-rank test, < 0·001).

CONCLUSIONS

All seven PEWS assessed demonstrate excellent predictive ability for CDE, in a heterogenous cohort. For evaluation of PEWS performance, CDE is a more appropriate outcome measure than hospital mortality, due to low mortality outside PICU. A standardised PEWS allows consistency, benchmarking and opportunity for continuing recalibration.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12887-025-05754-x.

摘要

背景

儿科早期预警评分（PEWS）通过重点监测生命体征来识别病情恶化风险的儿童，从而提高患者安全。然而，人们公认需要进行标准化。本研究的目的是比较在英国和爱尔兰临床实践中使用的七种PEWS（奥尔德希、床边、布里斯托尔、爱尔兰、纽卡斯尔、苏格兰以及英格兰提议的国家PEWS（第3版））的性能。主要结局是住院儿童发生严重病情恶化事件（CDE），次要结局是72小时医院死亡率。

方法

在12个月期间确定了250例患者病例。病例与对照按2:1匹配；根据年龄范围和收治专科进行匹配。计算PEWS以及性能特征。在CDE或出院前24、12、6和4小时计算最大PEWS，并使用受试者工作特征曲线下面积（AUC）来衡量性能。亚组分析探讨了在观察到病情恶化风险增加的3个专科中的性能。Kaplan-Meier生存曲线使用确定的最佳PEWS性能切点比较事件发生时间数据。