1
|
Relationship Between Body Temperature and Heart Rate in Children With No Other Apparent Cause of Tachycardia. Pediatr Emerg Care 2022; 38:644-649. [PMID: 35786789 DOI: 10.1097/pec.0000000000002617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the normal heart rate range for each body temperature in patients visiting the emergency department (ED) with no other, apparent, coexisting factors causing tachycardia. METHODS This was an observational study conducted in the ED at a single children's hospital between April 1, 2014, and March 31, 2017. Data on all visits were extracted from the electronic triage system and were excluded if they indicated the presence of factors other than body temperature potentially increasing the heart rate. We created age-dependent heart rate percentile curves for body temperature in 6 age categories: 0 to younger than 3 months, 3 to younger than 12 months, 1 to younger than 2 years, 2 to younger than 5 years, 5 to younger than 10 years, and 10 years or older. The curves were created for the body temperatures of 36.0°C to 38.0°C for the 0 to younger than 3 months age group and for body temperatures of 36.0°C to 40.5°C for the other age groups. RESULTS Of the 113,242 patients included, 61,321 were analyzed. The percentile curves across all age groups were similar despite differences in the baseline heart rate. Heart rate increase was steepest between 37.0°C and 38.0°C at a rate of approximately 20 beats per minute per degree Celsius for all groups. Compared with previous studies in the outpatient setting, including the ED, heart rate was lower in younger patients and was similar among older patients. CONCLUSIONS We created new, age-dependent heart rate percentile curves for body temperature for use in the ED setting. In outpatients, the effect of coexisting factors affecting heart rate, such as crying, may be higher among younger patients.
Collapse
|
2
|
Hannon C, Roland D, O'Sullivan R. Prediction of Pediatric Patient Admission/Discharge in the Emergency Department: Irish Pediatric Early Warning Score, Pediatric Observation Priority Score, and Irish Children's Triage System. Pediatr Emerg Care 2022; 38:e1320-e1326. [PMID: 35639436 DOI: 10.1097/pec.0000000000002639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the ability of the Irish Paediatric Early Warning Score (PEWS), the Paediatric Observation Priority Score (POPS), and the Irish Children's Triage System (ICTS) to predict patient disposition pathways in an emergency department (ED) setting. METHODS Data were prospectively collected on patients aged less than 16 years presenting to an Irish mixed adult/pediatric ED over 3 weeks during December 2018. After calculating a once-off PEWS, POPS, and ICTS, we investigated the ability of the scoring systems to predict admission or discharge from the ED. Primary comparison of the index tests was conducted using receiver operating characteristic (ROC) curves. RESULTS A total of 550 patients were included in this study. There were 114 admissions (20.7%) and 436 discharges (79.3%). The POPS had an area under the ROC curve of 0.7 [95% confidence interval (CI), 0.65-0.75]. The PEWS had an area under the ROC curve of 0.58 (95% CI, 0.53-0.64). The ICTS had an area under the ROC curve of 0.58 (95% CI, 0.53-0.63). CONCLUSIONS The POPS has greater accuracy as a predictor of admission from the ED than PEWS and ICTS. Possible future implementation of POPS into pediatric EDs as a cognitive prompt before admission decision seems to be merited. Further multicenter validation in Ireland would be helpful.
Collapse
Affiliation(s)
- Colm Hannon
- From the School of Medicine, University College Cork, Cork, Ireland
| | | | | |
Collapse
|
3
|
Wati L, Malisie RF, Harahap J. Pediatric Observational Priority Score and Early Warning Scoring System to Predict Admission Status in Pediatric Patients in Haji Adam Malik General Hospital. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Doctors must be able to quickly and accurately assess clinical condition of patients, especially in the emergency rooms. An easy scoring system but producing meaningful clinical conclusions is the reason for creating various scoring systems. Includes a scoring system for predicting the admission status of patients.
Aim: To determine the diagnostic value of POPS and EWSS to predicting admission status of pediatric patients in the emergency department.
Methods: Diagnostic tests for POPS and EWSS were done to predict the admission status of pediatric patients in the emergency department of Haji Adam Malik general hospital from May to October 2020. Subjects aged 1 month to 18 years were excluded if they left the emergency department prior to assessment, had trauma cases, died, inpatients due to social indications, and patients who came only to continue therapy were also excluded. POPS and EWSS assessments were carried out by the researcher and the admission status of the patients were determined by the doctor in charge in the emergency department.
Results: There were 119 children meeting the inclusion and exclusion criteria. POPS score ≥3 had sensitivity 82.65%, specificity 85.71%, and AUC 0.88 (p <0.001). EWSS score ≥2 had sensitivity 83.67%, specificity 71.43%, and AUC 0.83 (p <0.001).
Conclusion: POPS and EWSS had good diagnostic values in predicting the admission status of pediatric patients in the emergency department. POPS has a slightly higher diagnostic value than EWSS.
Collapse
|
4
|
Heal C, Cotterill S, Rowland AG, Garratt N, Long T, Brown S, O'Connor G, Rishton C, Woby S, Roland D. Inter-rater reliability of paediatric emergency assessment: physiological and clinical features. Arch Dis Child 2021; 106:149-153. [PMID: 32988814 PMCID: PMC7841473 DOI: 10.1136/archdischild-2019-318664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Paediatric Admission Guidance in the Emergency Department (PAGE) score is an assessment tool currently in development that helps predict hospital admission using components including patient characteristics, vital signs (heart rate, temperature, respiratory rate and oxygen saturation) and clinical features (eg, breathing, behaviour and nurse judgement). It aims to assist in safe admission and discharge decision making in environments such as emergency departments and urgent care centres. Determining the inter-rater reliability of scoring tools such as PAGE can be difficult. The aim of this study was to determine the inter-rater reliability of seven clinical components of the PAGE Score. DESIGN Inter-rater reliability was measured by each patient having their clinical components recorded by two separate raters in succession. The first rater was the assessing nurse, and the second rater was a research nurse. SETTING Two emergency departments and one urgent care centre in the North West of England. Measurements were recorded over 1 week; data were collected for half a day at each of the three sites. PATIENTS A convenience sample of 90 paediatric attendees (aged 0-16 years), 30 from each of the three sites. MAIN OUTCOME MEASURES Two independent measures for each child were compared using kappa or prevalence-adjusted bias-adjusted kappa (PABAK). Bland-Altman plots were also constructed for continuous measurements. RESULTS Inter-rater reliability ranged from moderate (0.62 (95% CI 0.48 to 0.74) weighted kappa) to very good (0.98 (95% CI 95 to 0.99) weighted kappa) for all measurements except 'nurse judgement' for which agreement was fair (0.30, 95% CI 0.09 to 0.50 PABAK). Complete information from both raters on all the clinical components of the PAGE score were available for 73 children (81%). These total scores showed good' inter-rater reliability (0.64 (95% CI 0.53 to 0.74) weighted kappa). CONCLUSIONS Our findings suggest different nurses would demonstrate good inter-rater reliability when collecting acute assessments needed for the PAGE score, reinforcing the applicability of the tool. The importance of determining reliability in scoring systems is highlighted and a suitable methodology was presented.
Collapse
Affiliation(s)
- Calvin Heal
- Centre for Biostatistics, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - Sarah Cotterill
- Centre for Biostatistics, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - Andrew Graeme Rowland
- School of Health and Society, The University of Salford, Salford, UK,Emergency Department, North Manchester General Hospital, Manchester, UK
| | | | - Tony Long
- School of Health and Society, The University of Salford, Salford, UK
| | | | | | | | - Steve Woby
- Northern Care Alliance NHS Group, Salford, UK
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Royal Infirmary, Leicester, UK,SAPHIRE Group, University of Leicester, Leicester, UK
| |
Collapse
|
5
|
Rowland A, Cotterill S, Heal C, Garratt N, Long T, Bonnett LJ, Brown S, Woby S, Roland D. Observational cohort study with internal and external validation of a predictive tool for identification of children in need of hospital admission from the emergency department: the Paediatric Admission Guidance in the Emergency Department (PAGE) score. BMJ Open 2020; 10:e043864. [PMID: 33384399 PMCID: PMC7780516 DOI: 10.1136/bmjopen-2020-043864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To devise an assessment tool to aid discharge and admission decision-making in relation to children and young people in hospital urgent and emergency care facilities, and thereby improve the quality of care that patients receive, using a clinical prediction modelling approach. DESIGN Observational cohort study with internal and external validation of a predictive tool. SETTING Two general emergency departments (EDs) and an urgent care centre in the North of England. PARTICIPANTS The eligibility criteria were children and young people 0-16 years of age who attended one of the three hospital sites within one National Health Service (NHS) organisation. Children were excluded if they opted out of the study, were brought to the ED following their death in the community or arrived in cardiac arrest when the heart rate and respiratory rate would be unmeasurable. MAIN OUTCOME MEASURES Admission or discharge. A participant was defined as being admitted to hospital if they left the ED to enter the hospital for further assessment, (including being admitted to an observation and assessment unit or hospital ward), either on first presentation or with the same complaint within 7 days. Those who were not admitted were defined as having been discharged. RESULTS The study collected data on 36 365 participants. 15 328 participants were included in the final analysis cohort (21 045 observations) and 17 710 participants were included in the validation cohort (23 262 observations). There were 14 variables entered into the regression analysis. Of the 13 that remained in the final model, 10 were present in all 500 bootstraps. The resulting Paediatric Admission Guidance in the Emergency Department (PAGE) score demonstrated good internal validity. The C-index (area under the ROC) was 0.779 (95% CI 0.772 to 0.786). CONCLUSIONS For units without the immediate availability of paediatricians the PAGE score can assist staff to determine risk of admission. Cut-off values will need to be adjusted to local circumstance. STUDY PROTOCOL The study protocol has been published in an open access journal: Riaz et al Refining and testing the diagnostic accuracy of an assessment tool (Pennine Acute Hospitals NHS Trust-Paediatric Observation Priority Score) to predict admission and discharge of children and young people who attend an ED: protocol for an observational study. BMC Pediatr 18, 303 (2018). https://doi.org/10.1186/s12887-018-1268-7. TRIAL REGISTRATION NUMBER The protocol has been published and the study registered (NIHR RfPB Grant: PB-PG-0815-20034; ClinicalTrials.gov:213469).
Collapse
Affiliation(s)
- Andrew Rowland
- CYP@Salford, School of Health and Society, University of Salford, Salford, UK
- Emergency Department, North Manchester General Hospital, The Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Sarah Cotterill
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Calvin Heal
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Natalie Garratt
- Northern Care Alliance NHS Group, Salford Royal Hospital, Salford, UK
| | - Tony Long
- CYP@Salford, School of Health and Society, University of Salford, Salford, UK
| | | | - Stephen Brown
- Northern Care Alliance NHS Group, Salford Royal Hospital, Salford, UK
| | - Steve Woby
- CYP@Salford, School of Health and Society, University of Salford, Salford, UK
- Northern Care Alliance NHS Group, Salford Royal Hospital, Salford, UK
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| |
Collapse
|
6
|
Long T, Rowland A, Cotterill S, Woby S, Heal C, Garratt N, Brown S, Roland D. Opt-out Consent in Children's Emergency Medicine Research. Compr Child Adolesc Nurs 2020; 45:1-12. [PMID: 32936676 DOI: 10.1080/24694193.2020.1812766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
There is global acceptance that individuals should be allowed to decide whether or not to take part in research studies, and to do so after being informed about the nature of the research and the risk that might attach to participation. The process of providing detailed information before seeking consent (formalized by signatures) in advance of undertaking research procedures may not be possible in some circumstances, and sometimes an amended approach may be adopted. The use of opt-out consent has been recognized as a valid and ethical means of recruiting participants to studies particularly with large samples and where the risk to participants is small. However, it is sometimes misunderstood and can be a problematic factor in being accepted by research ethics committees and governing authorities. This may be due partly to differing expectations of the amount of information and support offered, together with the nature of the process that is adopted to ensure that a decision has been made rather than consent simply being assumed. In accordance with ongoing discussions with young people, and following consultation with parents, an opt-out consent strategy including varied means of providing information was employed in a large study of 44,501 cases of children attending emergency or urgent care departments. The study was conducted over more than 12 months in dissimilar emergency departments and an urgent care unit, and was designed to support better decision-making in pediatric emergency departments about whether children need to be admitted to hospital or can be discharged home safely. Robust analysis of the factors that exerted the greatest impact on predicting the need to admit or the safety of discharging children led to a revised version of an existing tool. In this article, we review approaches to consent in research, the nature and impact of opt-out consent, the factors that made this an effective strategy for this study, but also more recent concerns which may make opt-out consent no longer acceptable.
Collapse
Affiliation(s)
- Tony Long
- School of Health & Society, University of Salford, Salford, UK
| | - Andrew Rowland
- School of Health & Society, University of Salford, Salford, UK
- Emergency Department, North Manchester General Hospital, The Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Sarah Cotterill
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Steve Woby
- School of Health & Society, University of Salford, Salford, UK
- Northern Care Alliance NHS Group, Salford, UK
| | - Calvin Heal
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | | | - Steve Brown
- Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Damian Roland
- Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
- Paediatric Emergency Medicine, SAPPHIRE Group, University of Leicester, Leicester, UK
| |
Collapse
|
7
|
Wee BYH, Lee JH, Mok YH, Chong SL. A narrative review of heart rate and variability in sepsis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:768. [PMID: 32647693 PMCID: PMC7333166 DOI: 10.21037/atm-20-148] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Clinicians face challenges in the timely diagnosis and management of pediatric sepsis. Pediatric heart rate has been incorporated into early warning systems and studied as a predictor for critical illness. We aim to review: (I) the role of heart rate in pediatric warning systems and (II) the role of heart rate variability (HRV) in adult and neonatal sepsis, with a focus on its potential applications in pediatrics. We conducted a literature search for papers published up to December 2019 on the utility of heart rate and HRV analysis in the diagnosis and management of sepsis, using four medical databases: PubMed, Google Scholar, EMBASE and Web of Science. This review demonstrates that the clinical utility of pediatric heart rate in predicting clinical deterioration is limited by the lack of consensus among warning systems, consensus-based guidelines, and evidence-based studies as to what constitutes abnormal heart rate in the pediatric age group. Current studies demonstrate that abnormal heart rate itself does not adequately discriminate children with sepsis from those without. HRV analysis provides a quick and non-invasive method of assessment and can provide more information than traditional heart rate. HRV analysis has the potential to add value in identification and prognostication of adult and neonatal sepsis. With further studies to explore its role, HRV analysis has the potential to add to current tools in the diagnosis and prognosis of pediatric sepsis.
Collapse
Affiliation(s)
- Benjamin Yi Hao Wee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Yee Hui Mok
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Shu-Ling Chong
- Duke-NUS Medical School, Singapore, Singapore.,Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| |
Collapse
|
8
|
Corfield AR, Clerihew L, Stewart E, Staines H, Tough D, Rooney KD. The discrimination of quick Paediatric Early Warning Scores in the pre-hospital setting. Anaesthesia 2019; 75:353-358. [PMID: 31828768 DOI: 10.1111/anae.14948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2019] [Indexed: 01/09/2023]
Abstract
In our previous study, a Paediatric Early Warning Score could be calculated for only one-fifth of 102,993 children transported by ambulance to hospital, as components other than supplemental oxygen were not reliably measured: respiratory rate 90,358 (88%); Glasgow Coma Score 83,648 (81%); heart rate 83,330 (81%); time to capillary reperfusion 81,685 (79%); oxygen saturation 71,372 (69%); temperature 60,402 (59%); systolic blood pressure 37,088 (36%). We tested 12 abbreviated scores with 3-5 components. The discrimination of these 12 scores for the primary outcome (30-day mortality or admission to paediatric intensive care), as measured by the area under the receiving operator characteristic curve, ranged from 0.69 to 0.80. Scores could be calculated for at most 74,508 (72%) children when heart rate, conscious level and respiratory rate were measured, with or without supplemental oxygen: the discrimination of these two versions was 0.75 and 0.77, respectively. Optimal threshold scores of 3 and 2 for these two abbreviated versions discriminated an outcome rate of 2-3% in about one third of children from the other children who had < 1% rate of outcome.
Collapse
Affiliation(s)
- A R Corfield
- Department of Emergency Medicine, Royal Alexandra Hospital, Paisley, UK
| | - L Clerihew
- Department of Paediatrics, Ninewells Hospital, Dundee, UK
| | - E Stewart
- University of the West of Scotland, Institute for Research in Healthcare Policy and Practice, School of Health and Life Science, Hamilton Campus, South Lanarkshire, UK
| | - H Staines
- Sigma Statistical Services, Balmullo, UK
| | - D Tough
- Clinical Directorate, Scottish Ambulance Service, Edinburgh, UK
| | - K D Rooney
- Department of Anaesthetics and Intensive Care, Royal Alexandra Hospital, Paisley, UK.,University of the West of Scotland, Institute for Research in Healthcare Policy and Practice, School of Health and Life Science, Hamilton Campus, South Lanarkshire, UK
| |
Collapse
|
9
|
Roland DT, Rowland A, Cotterill S, Heal C, Woby S, Garratt N, Brown S, Long T. Fine balance between pragmatism and rigidness in system approaches to acute care. BMJ 2019; 367:l6226. [PMID: 31672912 DOI: 10.1136/bmj.l6226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Damian T Roland
- Children's Emergency Department, Leicester Royal Infirmary, Leicester LE1 5UE, UK
| | - Andrew Rowland
- Pennine Acute Hospitals NHS Trust, Emergency Department, Manchester M8 5RB, UK
| | - Sarah Cotterill
- Centre for Biostatistics, Jean McFarlane, University of Manchester, Manchester M13 9PYL, UK
| | - Calvin Heal
- Centre for Biostatistics, Jean McFarlane, University of Manchester, Manchester M13 9PYL, UK
| | - Steve Woby
- Department for Research and Innovation, Northern Care Alliance NHS Group, Salford M5 5AP, UK
| | - Natalie Garratt
- Department for Research and Innovation, Northern Care Alliance NHS Group, Salford M5 5AP, UK
| | - Stephen Brown
- Department for Research and Innovation, Northern Care Alliance NHS Group, Salford M5 5AP, UK
| | - Tony Long
- Mary Seacole Building, University of Salford, Salford M6 6PU, UK
| |
Collapse
|
10
|
Moylan A, Maconochie I. Demand, overcrowding and the pediatric emergency department. CMAJ 2019; 191:E625-E626. [PMID: 32392478 DOI: 10.1503/cmaj.190610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Alexander Moylan
- Department of Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, UK
| | - Ian Maconochie
- Department of Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, UK
| |
Collapse
|
11
|
Chapman SM, Maconochie IK. Early warning scores in paediatrics: an overview. Arch Dis Child 2019; 104:395-399. [PMID: 30413488 DOI: 10.1136/archdischild-2018-314807] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 01/05/2023]
Abstract
Paediatric Early Warning Scores (PEWS)are used in hospitalised patients to detect physiological deterioration and is being used increasingly throughout healthcare systems with a limited evidence based. There are two versions in general use that can lead to a clinical response, either by triggering an action or by reaching a 'threshold' when graduated responses may occur depending on the value of the score. Most evidence has come from research based on paediatric inpatients in specialist children's hospitals, although the range of research is expanding, taking into account other clinical areas such as paediatric intensive care unit, emergency department and the prehospital setting. Currrently, it is uncertain whether a unified system does deliver benefits in terms of outcomes or financial savings, but it may inform and improve patient communication. PEWS may be an additional tool in context of a patient's specific condition, and future work will include its validation for different conditions, different clinical settings, patient populations and organisational structure. The incorporation of PEWS within the electronic health records may form a keystone of the safe system framework and allow the development of consistent PEWS system to standardise practice.
Collapse
Affiliation(s)
- Susan M Chapman
- International and Private Patients Division, Great Ormond Street Hospital, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ian K Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, London, UK.,Imperial College, London, UK
| |
Collapse
|
12
|
Paediatric early warning scores are predictors of adverse outcome in the pre-hospital setting: A national cohort study. Resuscitation 2018; 133:153-159. [PMID: 30336232 DOI: 10.1016/j.resuscitation.2018.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/17/2018] [Accepted: 10/11/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Physiological deterioration often precedes clinical deterioration as patients develop critical illness. Use of a specific Paediatric Early Warning Score (PEWS), based on basic physiological measurements, may help identify children prior to their clinical deterioration. NHS Scotland has adopted a single national PEWS - PEWS (Scotland). We aim to look at the utility of PEWS (Scotland) in unselected paediatric ambulance patients. METHODS We performed a retrospective cohort of all ambulance patients aged under 16 years conveyed to hospital in Scotland between 2011 and 2015. Patients were matched to their 30 day mortality and ICU admission using data linkage. RESULTS Full results were available for 21,202 children and young people (CYP). On multivariate logistic regression, PEWS (Scotland) was an independent predictor of the primary outcome (ICU admission within 48 h or death within 30 days) with an odds ratio of 1.403 (95%CI 1.349-1.460, p < 0.001). Area Under Receiving Operator Curve (AUROC) for aggregated PEWS was 0.797 (95% CI 0.759 to 0.836, p < 0.001). The optimal PEWS using Youlden's Index was 5. DISCUSSION These data show PEWS (Scotland) to be a useful tool in a pre-hospital setting. A single set of physiological observations undertaken prior to arrival at hospital can identify a group of children at higher risk of an adverse in-hospital outcome. Paediatric care is becoming more specialised and focussed on a smaller number of centres. In this context, use of PEWS (Scotland) in the pre-hospital phase may allow changes to paediatric pre-hospital pathways to improve both admission to ICU and child mortality rates.
Collapse
|
13
|
Riaz S, Rowland A, Woby S, Long T, Livesley J, Cotterill S, Heal C, Roland D. Refining and testing the diagnostic accuracy of an assessment tool (PAT-POPS) to predict admission and discharge of children and young people who attend an emergency department: protocol for an observational study. BMC Pediatr 2018; 18:303. [PMID: 30223819 PMCID: PMC6142686 DOI: 10.1186/s12887-018-1268-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing attendances by children (aged 0-16 years) to United Kingdom Emergency Departments (EDs) challenges patient safety within the National Health Service (NHS) with health professionals required to make complex judgements on whether children attending urgent and emergency care services can be sent home safely or require admission. Health regulation bodies have recommended that an early identification systems should be developed to recognise children developing critical illnesses. The Pennine Acute Hospitals NHS Trust Paediatric Observation Priority Score (PAT-POPS) was developed as an ED-specific tool for this purpose. This study aims to revise and improve the existing tool and determine its utility in determining safe admission and discharge decision making. METHODS/DESIGN An observational study to improve diagnostic accuracy using data from children and young people attending the ED and Urgent Care Centre (UCC) at three hospitals over a 12 month period. The data being collected is part of routine practice; therefore opt-out methods of consent will be used. The reference standard is admission or discharge. A revised PAT-POPs scoring tool will be developed using clinically guided logistic regression models to explore which components best predict hospital admission and safe discharge. Suitable cut-points for safe admission and discharge will be established using sensitivity and specificity as judged by an expert consensus meeting. The diagnostic accuracy of the revised tool will be assessed, and it will be compared to the former version of PAT-POPS using ROC analysis. DISCUSSION This new predictive tool will aid discharge and admission decision-making in relation to children and young people in hospital urgent and emergency care facilities. TRIAL REGISTRATION NIHR RfPB Grant: PB-PG-0815-20034. ClinicalTrials.gov: 213469. Retrospectively registered on 11 April 2018.
Collapse
Affiliation(s)
- Samah Riaz
- Clinical Research Unit, Fairfield General Hospital, Bury, UK
| | - Andrew Rowland
- Emergency Department, North Manchester General Hospital, Manchester, UK
- School of Health & Society, University of Salford, Salford, UK
- The Pennine Acute Hospitals NHS Trust, Manchester, UK
- Northern Care Alliance NHS Group, Salford, UK
| | - Steve Woby
- Northern Care Alliance NHS Group, Salford, UK
| | - Tony Long
- School of Health & Society, University of Salford, Salford, UK
| | - Joan Livesley
- School of Health & Society, University of Salford, Salford, UK
| | - Sarah Cotterill
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Calvin Heal
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Damian Roland
- SAPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children’s Emergency Department, Leicester Royal Infirmary, Leicester, UK
| |
Collapse
|
14
|
Sandell JM, Maconochie IK. Paediatric early warning systems (PEWS) in the ED. Emerg Med J 2016; 33:754-755. [PMID: 27215761 DOI: 10.1136/emermed-2016-205877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Julian M Sandell
- Department of Child Health, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Ian K Maconochie
- Department of Accident & Emergency, Queen Elizabeth the Queen Mother Wing, Imperial College School of Medicine, St. Mary's Hospital, London, UK
| |
Collapse
|