Cohort study to test the predictability of the NHS Institute for Innovation and Improvement Paediatric Early Warning System

Archives of Disease in Childhood
B W MasonC V E Powell

Abstract

To test the predictability of the National Health Service Institute for Innovation and Improvement (NHSIII) Paediatric Early Warning System (PEWS) score to identify children at risk of developing critical illness. Cohort study. Admissions to all paediatric wards at the University Hospital of Wales between 1 December 2005 and 30 November 2006. Unscheduled paediatric high dependency unit (PHDU) admission, paediatric intensive care unit (PICU) admission and death. There were 9075 clinical observations from 1000 children. An NHSIII PEWS score of 2 or more, which triggers review, has a sensitivity of 73.2% (95% CI 62.2% to 82.4%), specificity of 75.2% (95% CI 74.3% to 76.1%), positive predictive value (PPV) of 2.6% (95% CI 2.0% to 3.4%), negative predictive value of 99.7% (95% CI 99.5% to 99.8%) and positive likelihood ratio of 3.0 (95% CI 2.6 to 3.4) for predicting PHDU admission, PICU admission or death. Six (37.5%) of the 16 children with an adverse outcome did not have an abnormal NHSIII PEWS score. The area under the receiver operating characteristic curve for the NHSIII PEWS score was 0.83 (95% CI 0.77 to 0.88). The NHSIII PEWS has a low PPV and its full implementation would result in a large number of false positive triggers....Continue Reading

References

Apr 10, 2007·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Richard J BrilliMary McBride
Nov 22, 2007·JAMA : the Journal of the American Medical Association·Paul J SharekStephen J Roth
Feb 6, 2008·Archives of Pediatrics & Adolescent Medicine·Elizabeth A HuntMarlene R Miller
Mar 25, 2009·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·James Tibballs, Sharon Kinney
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Sep 11, 2013·Pediatrics·Nienke SeigerHenriëtte A Moll

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Citations

Apr 12, 2016·Journal of Paediatrics and Child Health·Damian RolandFfion Davies
Aug 9, 2016·Resuscitation·Susan M ChapmanMark J Peters
Apr 12, 2017·Archives of Disease in Childhood·Peter J Lillitos, Ian K Maconochie
Jan 30, 2020·BMJ : British Medical Journal·Iain SmithTom McGovern
Mar 22, 2016·The Cochrane Database of Systematic Reviews·Joke M WielengaBronagh Blackwood
Feb 21, 2019·Archives of Disease in Childhood·Bob Phillips
May 12, 2016·Journal of Clinical Pharmacy and Therapeutics·M A AlanaziP J Lewis

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