(685) Evaluation of a Modified Pediatric Early Warning Scoring System: A Single-Center Study

Introduction: Pediatric early warning systems (PEWS) help identify patients at risk of clinical deterioration. The primary aim of our study was to determine if a locally adapted PEWS [KKH early warning score (KEWS)] can distinguish patients requiring transfer from general ward (GW) to high dependency unit (HDU) or pediatric intensive care unit (PICU) from those not needing a transfer.

Methods: We conducted a retrospective case-control study between January - December 2021. All unplanned GW to PICU/HDU transfer were included as cases. KEWS was a modified 7 items PEWS. The 7 items in KEWS were similar to the National Early Warning Score (NEWS) and comprised of 6 physiological parameters with a weighted score for supplemental oxygen. KEWS of patients at 2, 4, 6 hours prior to and at the time of transfer were calculated and collected. A ratio of 1:3 was used to match cases with controls (GW patients who did not require higher level of care). Variables with P value < 0.2 in the univariate model were selected for the multivariable model.

Results: In total, there were 784 patients (196 cases and 588 controls). Median age of the cases (IQR) was 3.3 (1.0–9.7) years and the most common indications for HD/PICU transfer were apnea/respiratory distress (28%), hypotension/tachycardia (15%) and seizures (13%). At all timepoints, KEWS was able to distinguish between children who required transfer to PICU/HDU and those who did not require transfer (At time of transfer: area under the curve = 0.80, 95% CI= 0.75-0.85, p < 0.001). On multivariable logistic regression, KEWS was an independent predictor of PICU/HDU transfer with an odds ratio of 2.34 (95% CI 1.82 to 3.00, p < 0.001). A cut-off score of 2 for KEWS has a sensitivity of 65.3% (95% CI 58.0 - 72.0%) and specificity 83.3% (95% CI 79.3 - 86.8%) for PICU/HDU transfer. Among patients who required PICU/HDU transfer, KEWS was able to predict those who required critical intervention (e.g., intubation, inotrope infusion) [AUC=0.72, (95% CI= 0.64 to 0.80)].

Conclusions: Higher KEWS were associated with increased risk of transfer from GW to PICU/HDU and patients needing critical intervention within 24 hours of admission to PICU/HDU. KEWS appears to be specific but not as sensitive. To improve performance, point-of-care tests may be incorporated into early warning systems.