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

Iris M Mandell; Francine Bynum; Lori Marshall; Robert Bart; Jeffrey I Gold; Sarah Rubin

doi:10.1016/j.jcrc.2015.06.019

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

J Crit Care. 2015 Oct;30(5):1090-5. doi: 10.1016/j.jcrc.2015.06.019. Epub 2015 Jul 4.

Authors

Iris M Mandell¹, Francine Bynum², Lori Marshall³, Robert Bart⁴, Jeffrey I Gold⁵, Sarah Rubin⁶

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.
² Department of Pediatrics, Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, CA; Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA.
³ Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA.
⁴ Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA; Department of Health Services, Los Angeles County, Los Angeles, CA; Departments of Pediatrics and Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, CA.
⁵ Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA; Departments of Pediatrics and Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, CA.
⁶ Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA; Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA. Electronic address: SarRubin@chla.usc.edu.

PMID: 26235654
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) 18years 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 48hours 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.

Keywords: PEWS; PICU readmission; Severity of illness.

Publication types

Evaluation Study

MeSH terms

Adolescent
Area Under Curve
Case-Control Studies
Child
Chronic Disease
Critical Care / statistics & numerical data*
Female
Humans
Infant
Intensive Care Units, Pediatric / statistics & numerical data*
Length of Stay / statistics & numerical data
Male
Patient Discharge / statistics & numerical data
Patient Readmission / statistics & numerical data*
Retrospective Studies
Severity of Illness Index*