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Objective:To design a pediatric early warning score (PEWS) ruler and observe the effect of its application in the nursing of critically ill children hospitalized in neurology department.Methods:A total of 200 critically ill children admitted to Department of Neurology of Hunan Children′s Hospital from 2018 to 2019. 98 cases who were hospitalized from January to September 2019 were selected as the observation group, and 102 cases who were hospitalized from January to September 2018 were set as the control group. The control group received conventional care, while the observation group conducted PEWS ruler for nursing intervention on the basis of conventional care. The differences in hospital days, ICU transfer rate, and frequency of medical intervention between the two groups were compared.Results:The hospital days of the control group and observation group were 18.17 ± 6.33 and 13.33 ± 6.38 respectively, and the difference between the two groups was significant ( t=5.38, P<0.01). The ICU transfer rate was significantly different between the control group 17.6% (18/102) and observation group 8.2% (8/98) ( χ2=3.98, P<0.05). The reduction of increased intracranial pressure, cooling, calm, sedation and oxygen breathing in the control group were 6.86% (7/102), 13.73% (14/102), 6.86% (7/102), 7.84% (8/102), while the observation group were 17.35% (17/98), 27.55% (27/98), 24.49% (24/98), 28.57% (28/98), and the differences between the two groups were significant ( χ2 values were 5.20-14.55, all P<0.05). Conclusions:The application of PEWS ruler is helpful for nurses to recognize the progress of diseases of the critically ill children. Also, it can shorten the hospitalization days of these children, reduce the ICU transfer rate, as well as improve the nursing quality for them.
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Objective@#A graded response system based on pediatric early warning score (PEWS) was constructed to provide a scientific basis for clinical intervention and management by clinical nurses.@*Methods@#Domestic and foreign literature and the results of previous research were reviewed to build a preliminary framework of graded response strategies. Two rounds of expert consultation were conducted by Delphi method and the results were statistically analyzed. Meanwhile, the results were integrated into the electronic medical record system to form the PEWS grading response system.@*Results@#The positive coefficient of experts in the first and second rounds of consultation both were 15/15, and the average of the expert authority coefficient was 0.87 and 0.89 respectively. The expert coordination degree Kendall′s W value was 0.292 and 0.301 respectively (P<0.05), indicating that the experts′ opinions tended to be consistent. Finally, four segmented response systems were formed, with PEWS scored on the scale of 0-1, 2, 3 and 4 or single 3 points.@*Conclusions@#The graded response system based on pediatric early warning score constructed by using Delphi expert consultation method can be used in clinic, which can promote the nurses′ participation in clinical intervention decision-making and improve the quality of nursing.
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The transport pediatric early warning score ( TPEWS) is a scoring tool for critically ill referrals. It could be used as a common language for inter￣hospital referrals to help the referral team accurately evaluate the severity of the referral′s condition and applied to emergency transshipment centers to help the transfer center prioritize the order of referrals which could make sufficient use of medicl resources. It also could be applied to assess whether the child needed hospitalization in the emergency department which could help to reduce the workload of the emergency department. This paper describes the development process of TPEWS and application status.
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Objective A graded response system based on pediatric early warning score (PEWS) was constructed to provide a scientific basis for clinical intervention and management by clinical nurses. Methods Domestic and foreign literature and the results of previous research were reviewed to build a preliminary framework of graded response strategies. Two rounds of expert consultation were conducted by Delphi method and the results were statistically analyzed. Meanwhile, the results were integrated into the electronic medical record system to form the PEWS grading response system. Results The positive coefficient of experts in the first and second rounds of consultation both were 15/15, and the average of the expert authority coefficient was 0.87 and 0.89 respectively. The expert coordination degree Kendall′s W value was 0.292 and 0.301 respectively (P<0.05), indicating that the experts′ opinions tended to be consistent. Finally, four segmented response systems were formed, with PEWS scored on the scale of 0-1, 2, 3 and 4 or single 3 points. Conclusions The graded response system based on pediatric early warning score constructed by using Delphi expert consultation method can be used in clinic, which can promote the nurses′participation in clinical intervention decision-making and improve the quality of nursing.
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Objective Critical hand foot and mouth disease(HFMD)progresses from severe type to critical type very fast with high mortality rate.The article was to explore the significance of pediatric early warning score and common inflammatory markers in early diagnosis of critical HFMD cases. Methods A retrospective analysis was conducted on 236 HFMD cases in Hainan Provincial People's Hospital from January 2014 to December 2016. According to HFMD diagnosis and treatment guidelines(2010 Edition)formulated by the Ministry of Health,the selected cases were divided into the general group(n=88),the severe group(n=128)and the critical group(n=20). The white blood cells(WBC),neutrophils(PMN), serum C reactive protein(CRP),procalcitonin(PCT)and other la-boratory parameters were collected at admission,along with Pediatric Early Warning score(PEWS)and Pediatric Critical Illness Score(PCIS). The data of each group were compared by ROC curve analysis. Results The median number of WBC and PMN in the criti-cal group was 15.36×109/L and 10.09×109/L,respectively,which were significantly higher than those of severe group(P<0.05). However,no significant difference was found between general group and severe group(P>0.05). The serum levels of CRP and PCT in general group were higher than those in severe group and critical group,and the difference was statistically significant(P<0.05). The PEWS[(6.1±2.42)vs(0.99±0.77)]and PCIS[(78.7±13.6)vs(99.03±2.12)]in critical group were significantly higher than those in severe group,which were of statistically significance(P<0.05). According to the ROC analysis,the area under the ROC curve of PEWS early warning score for children was(0.962~1.000),(P<0.05)and the best diagnosis limit PEWS was 3.5. The PEWS and PCIS correlation analysis showed the Pearson correlation coefficient was -0.885(P<0.05). Conclusion Common clini-cal inflammatory markers can not be taken as quantitative indicators for the early diagnosis of critical HFMD. The PEWS is an ideal quantitative index for early diagnosis of critical HFMD.
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Objective To retrospectively analyze the effect of Brighton Pediatric Early Warning Score (Brighton PEWS) on the disease identification of children with hand-foot-mouth disease(HFMD). Methods Collected the hospital medical records of the children from January 2016 to July 2017 in our hospital, then compared the identification of the Brighton PEWS with the real outcomes, and analyzed the prediction effect of the Brighton PEWS by plotting the ROC curve. Results The study retrospectively analyze 619 cases of medical records, The area under the ROC curve of the Brighton PEWS was 0.838 (P<0.01), when the cut-off was 1.5, the maximum Youden value was 0.532, the sensitivity was 63.4%, and the identification was 89.8%. Conclusions The Brighton PEWS had a good identification when the cut-off was 1.5, but the sensitivity was low, we need to improve the sensitivity of the Brighton PEWS by combining with the characteristics of HFMD.
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The early recognization and intervention of patients at risk of clinical deterioration plays an extreme-ly important role in improving the prognosis and decreasing mortality of those patients. Pediatric early warning score (PEWS)is a simple pediatric scoring system consisting of some physiological indicators.It can be used to dynamically evaluate the severity of illness either in pediatric emergency department or in inpatient wards and also to guide correspon-ding interventions.PEWS is easy to operate,time saving and also showed a good repeatability during clinical implemen-tion.So far,numerous clinical studies have demonstrated that PEWS shows high sensibility and specificity in early identifi-cation of clinical deterioration and is worthy of further clinical application.However,there is still no consensus about its cut-off score,which needs further substantial clinical research to verify.
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Objective To explore the significance of modified pediatric early warning score (MPEWS) in emergency early warning triage and classification. Method Selecting ill children who came to emergency department from February of 2017 to January of 2018 as objects of study, and triage nurses of emergency department gave MPEWS to the sick children under the demand of the filed data collection. Furthermore, according to the five levels of disease severity classification, doctors gave the disease assessment and classification to the sick children, finding the relevance between the MPEWS and the severity of the disease.Result Consequently, there is a relevance between the MPEWS scores and the severity of the disease indeed (rs=-0.630, P ＜ 0.001). The data show that the higher of the scores, the lower disease level, and the higher severity of the disease. ROC areas under the curve of the subjects is 0.996, and the confidence interval is 0.993-0.999 (P ＜0.05). That indicates that MPEWS exists statistical significance of emergency children judgement. The optimal number is 4.5, the sensitivity is 96％, and the specificity is 99.9％.Conclusions MPEWS is valuable in emergency early warning triage, children emergency severity assessment and identifying critical ill children in time.
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Objective To investigate the application of pediatric early warning score (PEWS) in neurology department.Methods The clinical data and PEWS of 1,158 children with neurologic diseases (764 febrile seizures,259 viral encephalitis and 135 bacterial meningitis) admitted into neurology department from August 2013 to November 2016 were analyzed retrospectively.PEWS was compared among the three different diseases.According to the disease severity,cases were categorized into no-monitor-required group (n =996,697 febrile seizures,203 viral encephalitis and 96 bacterial meningitis),monitor-required group (n =138,67 febrile seizures,41 viral encephalitis and 30 bacterial meningitis) and PICU group (n =24,0 febrile seizures,15 viral encephalitis and 9 bacterial meningitis).PEWS was assessed at admission in both no-monitor-required group and monitorrequired group.PEWS was recorded 12 hours before PICU transfer in PICU group.Then PEWS was compared among all groups in different diseases respectively.Results The median (minimum ～ maximum) of PEWS in febrile seizures,viral encephalitis and bacterial meningitis was 0 (0 ～ 3),2(0 ～ 8) and 2(0 ～ 8),respectively and there was significant difference among three diseases (P ＜ 0.01).No patient of febrile seizures was transferred to PICU.PEWS of febrile seizures in monitor-required group was higher than that in no-monitor-required group (P ＜ 0.01).For both viral encephalitis and bacterial meningitis,PEWS in monitor-required group was higher than that in no-monitorrequired group,and the score in PICU group was higher than that in monitor-required group.The difference was significant (P ＜ 0.01).Conclusion PEWS is effective for the assessment of illness severity of hospitalized children in neurology department,and can be used for the prediction PICU transfer as an excellent screening tool.
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Objective To explore the application and effects of pediatric early warning score (PEWS) on the early warning and identification of septic shock in acute lymphoblastic leukemia children with neutropenia and coinfection at bone marrow suppression period after chemotherapy. Methods A retrospective study of 57 acute lymphoblastic leukemia children with neutropenia and coinfection in a tertiary hospital in Changsha from January 2015 to May 2016 was conducted. PEWS was performed based on vital sign monitoring of children. ROC curve was established to evaluate the PEWS warning value when the sick children had septic shock. The obtained PEWS system was applied in the early warning of acute lymphoblastic leukemia children with neutropenia and coinfection from October 2016 to March 2017,and relative intervention measures including setting corresponding monitor level, oxygen uptake and fluid resuscitation were provided according to various PEWS warning value. The incidence of shock,death rate and the time of recovery between two groups before and after intervention were compared. Results The optimal cut off point of PEWS when children with neutropenia and coinfection had septic shock was 3.5. After intervention,the incidence of shock,death rate and the time of recovery were lower than those before intervention (P<0.05). Conclusion PEWS can provide effective early warnings for acute lymphoblastic leukemia children with neutropenia and coinfection. It is beneficial for disease recovery and subsequent chemotherapy of the patients.
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Objective To validate the efficacy of Pediatric Early Warning Score (PEWS) in severity evaluation of respiratory inpatients.Methods Four hundred and thirteen children with respiratory disease were hospitalized in Pneumology Department of Guangzhou Women and Children's Medical Centre from October 2012 to October 2013,of which 36 cases required Intensive Care Unit (ICU) treatment while the rest 377 controls did not.According to the disease severity,cases and controls were further categorized into 3 groups:no-monitor-required group (n =302,controls),monitor-required group (n =75,controls),ICU group (n =36).PEWS was assessed at admission in controls and 12 hours before ICU transfer,respectively.PEWS were compared among all groups and receiver operator characteristic curve(ROC) was performed.Results The median [interquartile rang(IQR)] age in ICU group was 10 months(4-13 months),monitor-required group was 10 months (6-16 months),and no-monitor-required group was 14months(6-24 months),and the difference was significant (H =13.59,P ＜ 0.01).The median (IQR) of PEWS in ICU group was 6 scores (6-7 scores),monitor-required groups was 5 scores (4-5 scores),on-monitor-required group was 2 scores (1-2 scores),and the difference was significant (x2 =255.641,P ＜ 0.01).PEWS in monitor required group and ICU group was 3.5 score with area under ROC (AUC) as 0.898 (95％ CI:0.867-0.929,sensitivity0.907,specificity 0.893) and 4.5 with AUC as 0.978 (95％ CI:0.964-0.992,sensitivity 1.000,specificity 0.862),respectively.Conclusions PEWS can be indicative for severity classification in hospitalized respiratory pediatric patients,and can serve as a potentially excellent screening tool for prediction of ICU admission.