Pediatric Early Warning Score and unplanned readmission to the pediatric intensive care unit

• Published in: Journal of critical care Vol. 30; no. 5; pp. 1090 - 1095
• Main Authors: Mandell, Iris M., MD, Bynum, Francine, MD, Marshall, Lori, PhD, Bart, Robert, MD, Gold, Jeffrey I., PhD, Rubin, Sarah, MD, MsCI
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2015; Elsevier Limited
• Subjects: Adolescent; Age; Area Under Curve; At risk youth; Case-Control Studies; Child; Children & youth; Chronic Disease; Chronic illnesses; Critical Care; Critical Care - utilization; Female; Heart rate; Hospitals; Humans; Infant; Intensive care; Intensive Care Units, Pediatric - utilization; Length of Stay - statistics & numerical data; Male; Mortality; Ostomy; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; PEWS; PICU readmission; Retrospective Studies; Severity of illness; Severity of Illness Index; Ventilation; United States > US; PEWS; Severity of illness; PICU readmission
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2015.06.019

Abstract Background and Objectives Early unplanned Pediatric Intensive Care Unit (PICU) readmission is associated with greater length of stay and mortality. No tools exist to identify children at risk for PICU readmission. The Pediatric Early Warning Score (PEWS) currently identify children at risk for deterioration on the ward. Our primary objective was to evaluate the ability of PEWS to identify children at risk for unplanned PICU readmission. Methods A single-center case-control study of 189 children (38 cases and 151 age-matched controls) 18 years or younger transferred from the PICU to the pediatric ward from January 1, 2010-March 30, 2013, at an urban tertiary care children's hospital was conducted. Results Thirty-eight cases had unplanned PICU readmission within 48 hours of transfer to pediatric ward, whereas 151 controls were not readmitted. The PEWS assigned prior to PICU discharge and first PEWS assigned on the ward were collected for cases and controls. Each 1-point increase in the PEWS score significantly increased risk of PICU readmission (odds ratios [95% confidence intervals], 1.6 [1.12-2.27; P = .009] and 1.89 [1.33-2.69; P < .001], respectively). Discrimination ability of PEWS for PICU readmission improved when chronic diagnoses were included. Conclusions Higher PEWS scores were associated with increased risk of unplanned PICU readmission. However, cutoff scores are not sensitive or specific enough to be clinically useful. Adding chronic disease variables may improve the clinical utility of cutoff PEWS scores.