Aim Our aim is to evaluate if Paediatric Illness Severity Assessment (PISA) and PEWS can be used as a combined tool for safe discharge of patients from Paediatric Observation and Assessment unit (POAU).
Method We reviewed the PISA and PEWS scoring on patients attending our POAU over a busy winter on three randomised days. All patients routinely had PEWS assessed by nursing staff at the time of admission, discharge and as needed in between these two. PISA was calculated from the clinical notes. The combined tool was used to assess whether patient needed admission or discharged home. If discharged home, data was collected if there were any complications or readmissions.
Results A total of 52 patients were studied. Their age range varied from 1 day to 15 years. 37 patients were discharged home and 15 were admitted to the hospital. All of the children who were discharged had an initial PEWS score of or less than 4 or had good response with the PEWS score dropping to 0 to 2 with intervention, while their PISA grading suggested mild or moderate risk. There were no major complications in those who were discharged home. One patient was readmitted, which the parent was already cautioned. 5 patients who were admitted to the hospital had PEWS score of 0 to 2 but their PISA grading was moderate to severe risk, indicating the need for hospital admission. All those with an initial PEWS scoring above 4 or those with persistent score above 3 needed hospital admission and their PISA grading suggested moderate risk. The combined PISA and PEWS tool, in our study, when used for discharge, had a sensitivity (the probability of the child being discharged) of 100% and specificity of 97.3% with a PEWS scoring below 2 and PISA grading of mild risk.
Conclusion The Combined tool with PISA and PEWS provides clinical guidance in safely discharging patients home from the observation and assessment unit. We recommend performing a prospective study to validate this combined tool in a larger study population.
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