OBJECTIVE: Pediatric early warning scores (PEWS) are being advocated for use in the emergency department (ED). The goal of this study was to compare the validity of different PEWS in a pediatric ED.
METHODS: Ten different PEWS were evaluated in a large prospective cohort. We included children aged <16 years who had presented to the ED of a university hospital in The Netherlands (2009−2012). The validity of the PEWS for predicting ICU admission or hospitalization was expressed by the area under the receiver operating characteristic (ROC) curves.
RESULTS: These PEWS were validated in 17 943 children. Two percent of these children were admitted to the ICU, and 16% were hospitalized. The areas under the ROC curves for predicting ICU admission, ranging from 0.60 (95% confidence interval [CI]: 0.57−0.62) to 0.82 (95% CI: 0.79–0.85), were moderate to good. The area under the ROC curves for predicting hospitalization was poor to moderate (range: 0.56 [95% CI: 0.55–0.58] to 0.68 [95% CI: 0.66–0.69]). The sensitivity and specificity derived from the ROC curves ranged widely for both ICU admission (sensitivity: 61.3%–94.4%; specificity: 25.2%–86.7%) and hospital admission (sensitivity: 36.4%–85.7%; specificity: 27.1%–90.5%). None of the PEWS had a high sensitivity as well as a high specificity.
CONCLUSIONS: PEWS can be used to detect children presenting to the ED who are in need of an ICU admission. Scoring systems, wherein the parameters are summed to a numeric value, were better able to identify patients at risk than triggering systems, which need 1 positive parameter.
- ATS —
- Australasian Triage Scale
- CI —
- confidence interval
- ED —
- emergency department
- ESI —
- Emergency Severity Index
- IQR —
- interquartile range
- MTS —
- Manchester Triage System
- PedCTAS —
- pediatric Canadian Triage and Acuity Scale
- PEWS —
- pediatric early warning scores
- ROC —
- receiver operating characteristic
- Accepted July 11, 2013.
- Copyright © 2013 by the American Academy of Pediatrics