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Education, Teaching, and Quality Improvement |

Utility of Pediatric Early Warning System (PEWS) Score and Medical Emergency Team (MET) Activations on Decisions to Implement Critical Care

Rosanne Salonia, MD; Amanda Silverio, BS; Adam Silverman, MD; Aaron Zucker, MD; Christopher Carroll, MD
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Connecticut Children's Medical Center, Hartford, CT


Chest. 2014;146(4_MeetingAbstracts):559A. doi:10.1378/chest.1994453
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Abstract

SESSION TITLE: Patient Safety Initiative Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Early identification of hospitalized patients at risk of clinical deterioration is vital to improving quality of care, patient safety and outcomes. Many children’s hospitals, including ours, have implemented a Pediatric Early Warning System (PEWS) score and use Medical Emergency Teams (MET) in order to identify and triage children with early signs of physiologic instability. The purpose of this study was to determine whether a combination of clinical variables and PEWS score components could be used to identify hospitalized children who require escalation of clinical care.

METHODS: Retrospective review of all MET activations between March 4, 2013 and January 6, 2014. Triggers for MET activations were a PEWS score > 7 or any clinical concern. Analysis of clinical variables and components of the PEWS score was performed to determine which variables were most predictive of PICU (Pediatric Intensive Care Unit) admission.

RESULTS: There were 192 MET activations for 145 patients during the study period. The median age of children was 5.5 yrs (range 0.3-23.7 yrs), median PEWS score 8 (range 1-20). 26% of METs resulted in PICU admission; with a PEWS score ≥ 7 having a sensitivity of 82% and specificity of 10%. Admission to the PICU following a MET was associated with a higher number of MET activations per patient (p=0.03), a PEWS score > 11 (OR 2.3; 95% CI, 1.1-4.7) and a lower PEWS heart rate sub-score (p=0.02). Children with asthma were less likely to be admitted to the PICU following a MET (OR 0.4; 95% CI, 0.2-0.9). No other clinical factors were discriminatory.

CONCLUSIONS: There were identifiable clinical components and thresholds of the PEWS score that were predictive of admission to the PICU, but overall the sensitivity and specificity of the PEWS was not strong.

CLINICAL IMPLICATIONS: Although the PEWS score has potential to enhance early detection of clinical deterioration, there are likely unmeasured factors that are more predictive. Further research is needed to identify reliable predictors of clinical deterioration and to evaluate the impact of the PEWS score on patient outcomes.

DISCLOSURE: The following authors have nothing to disclose: Rosanne Salonia, Amanda Silverio, Adam Silverman, Aaron Zucker, Christopher Carroll

No Product/Research Disclosure Information


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