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‘The Score Matters’: wide variations in predictive performance of 18 paediatric track and trigger systems
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  • Published on:
    "Human factors matter" - Statistical analysis of performance of trigger systems misses the point
    • Ronny Cheung, Consultant Paediatrician Evelina London Children's Hospital, Guy's & St Thomas' Foundation NHS Trust
    • Other Contributors:
      • Peter Lachman, Consultant Paediatrician & CEO

    Chapman et al (1) present a valuable evaluation of the performance characteristics of 18 commonly used paediatric early warning systems. They observed that the performance of the 12 “scoring” systems (where cumulative component values for vital signs are used to identify thresholds for escalation of care) was superior to 6 “trigger” systems (where breaching set thresholds for one or more vital signs lead to escalation without the need for adding numerical scores), based on sensitivity, specificity and area under the operating curve (AUROC). Although they do not specifically claim that this finding should be extrapolated to suggest that all scoring systems outperform trigger systems, this is the implication both in the results and discussion section. Indeed, the associated editorial by Lillitos & Maconochie confirms this implied conclusion, when they state that “In conclusion…overall, PEWS perform better than Trigger systems.” (2)

    We contend that this is an erroneous and misleading conclusion and far outstrips the scope and methodology of the study. Firstly, the findings are related to the performance of 16 specific tools and no comment can be made about whether it is the Trigger or the Score aspects which are responsible for this difference. Using the analogy of a therapeutic trial, there can be no basis to conclude that this is a “class effect” rather than specific to each tool. Secondly, the authors themselves recognise that it is the thresholds for escalation...

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    Conflict of Interest:
    None declared.