Identifying high risk children in the emergency department

Abstract

Objectives: Early warning scores reduce the occurrence of in-hospital cardiac arrest by identifying high-risk hospitalized patients prior to clinical deterioration. However, the ability of early warning scores to identify high-risk pediatric patients in the emergency department (ED) has not been evaluated. We aimed to determine the association between the modified pediatric early warning score (MPEWS) in the ED and clinical deterioration that necessitated subsequent inpatient ward-to-pediatric intensive care unit (PICU) transfer within 24 hours of admission. Methods: This is a case-control study of 597 pediatric patients admitted from the ED to the inpatient ward at Seattle Children's Hospital between July 1, 2010 and December 31, 2011. Cases were admitted to the inpatient ward and transferred to the PICU within 24 hours, whereas controls remained hospitalized on the inpatient ward at 24 hours. The association between MPEWS in the ED and ward-to-PICU transfer was determined by chi square analysis. Results: There were no differences in demographic characteristics between cases and controls. Children with an MPEWS of 7 or greater in the ED were relatively more likely to be transferred to the PICU within 24 hours (OR 8.36, 95% CI 2.98, 22.08). However, an MPEWS threshold of 7 yielded a sensitivity of only 18.0% and a specificity of 97.4%. Conclusions: Elevated MPEWS in the ED is associated with increased risk of ward-to-PICU transfer within 24 hours of admission; however, an MPEWS of 7 or higher is not sufficient to identify more than a small proportion of children with subsequent clinical deterioration.