Aims: The evidence of the utility of early warning scores in children is growing. In addition to tracking deteriorating patients the same scores have been evaluated for their ability to recognise severely unwell children and predict the need for hospital and/or HDU admission. In this study, we investigated their effectiveness in predicting length of stay (LOS) and HDU admission in children with bronchiolitis as per the research recommendations in the new NICE guidelines (NG9).
Methods: We carried out a prospective observational study of children admitted to the Children’s Ward at Colchester General Hospital with a diagnosis of bronchiolitis (November–February 2016). Data was obtained from hospital notes and electronic patient information and analysed using GraphPad Prism 7 for Mac. We examined the correlation between PEWS on admission and LOS as well as the difference in PEWS at presentation between children who required HDU for CPAP and Vapotherm and those that did not.
Results: 73 children were admitted with a mean age 4.7 months and of which 34 (46.6%) were boys, and 39 (53.4%) were girls. Mean LOS was 3.8 days. 18 (24.7%) children were admitted to HDU for Vapotherm, CPAP or both and the mean HDU LOS was 1.99 days. PEWS on admission correlated with LOS (r=0.43, CI: 0.22–0.60, P<0.001) and LOS was significantly higher in patients presenting with a PEWS of >5 (P=0.01). Children who required HDU presented with a higher PEWS than those that did not (4.2±1.7 vs 2.3±1.3; P=0.0006).
Conclusion: PEWS on admission correlated with LOS in children with bronchiolitis and children that required HDU admission during their admission presented with a significantly higher PEWS. Recording PEWS on admission might be useful in identifying the children that might deteriorate and will go onto to need more intensive care & management.
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