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The effectiveness of the paediatric early warning tool (PEWT) in identifying children requiring admission to a critical care unit
  1. K O'Loughlin1,
  2. K Ruparelia2,
  3. T Vince1,
  4. S Bedford1,
  5. SB Drysdale1,
  6. S Broughton1
  1. 1Department of Paediatrics, King's College Hospital, London, UK
  2. 2Department of Medicine, King's College London, London, UK

Abstract

Introduction The Paediatric Early Warning Trigger (PEWT) Tool is used at our hospital to aid early identification of clinical deterioration and promote effective escalation of care. Our hospital is a teaching hospital, with inpatient general, respiratory, haematology, surgery, neurosurgery, hepatology and gastroenterology beds and a paediatric critical care unit (CCU).

Method The use of PEWT was prospectively audited during July 2010 for all Paediatric admissions, excluding critical care or NICU admissions. All observation charts included a PEWT scoring system that assessed 5 physiological parameters. The data were collected twice daily using a standard proforma including demographics, documentation of triggering, frequency of triggering and admission to CCU.

Results Data was collected on 331 children (age [range] 6.3 [0.01-18.6] years), 62 (19%) children triggered. Seven children (all of whom triggered) were admitted to CCU. The children admitted to CCU were more likely to have triggered in more than one time period (median [range] number of triggers 3 [1-7] v 0 [0-16], p<0.0001). Overall, identification of triggering on PEWT detected CCU admission with a sensitivity of 100% and a specificity of 83% with a positive predictive value of 0.13 and a negative predictive value of 1.00. Area under receiver operated curve (AUC) analysis showed that triggering PEWT was highly predictive of CCU admission (AUC [95% CI] 0.91 [0.87-0.96]) as was the number of triggering epochs (AUC [95% CI] 0.92 [0.88-0.97]).

Conclusion Triggering PEWT is strongly associated with CCU admission. However, given its low positive predictive value, PEWT has poor efficacy for establishing the need for critical care based on triggering scores alone. Therefore, CCU admission may not be the most appropriate outcome measure for evaluating the effectiveness of PEWT, instead effectiveness of interventions would be more appropriate but more difficult to measure. If a national paediatric scoring system is to be developed it will need to be designed to detect effectiveness of interventions.

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