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Use of paediatric early warning scores in intermediate care units
  1. Marie Emilie Lampin1,2,
  2. Alain Duhamel2,3,
  3. Hélène Behal3,
  4. Morgan Recher4,
  5. Francis Leclerc2,4,
  6. Stéphane Leteurtre2,4
  1. 1 Service de Réanimation Pediatrique, CHU Lille, F-59000 Lille, France
  2. 2 EA 2694—Santé Publique: épidémiologie et qualité des soins, Université de Lille, Lille, France
  3. 3 Service de Biostatistiques, CHU Lille, F-59000 Lille, France
  4. 4 Service de Réanimation Pédiatrique, CHU Lille, F-59000 Lille, France
  1. Correspondence to Dr Marie Emilie Lampin, Service de Réanimation Pediatrique, CHU Lille, Lille 59000, France; marie-emilie.lampin{at}


Objective Paediatric early warning scores (EWS) were developed to detect deterioration in paediatric wards or emergency departments. The aim of this study was to assess the relationship between three paediatric EWS and clinical deterioration detected by the nurse in paediatric intermediate care units (PImCU).

Methods This was a prospective, observational, multicentre study at seven French regional hospitals that included all children <18 years of age. Clinical parameters included in three EWS (Paediatric Advanced Warning Score, Paediatric Early Warning Score and Bedside Paediatric Early Warning System) were prospectively recorded every 8 hours or in case of deterioration. The outcome was a call to physician by the nurse when a clinical deterioration was observed. The cohort was divided into derivation and validation cohorts. An updated methodology for repeated measures was used and discrimination was estimated by the area under the receiver-operating curve.

Results A total of 2636 children were included for 14 708 observations to compute a posteriori the EWS. The discrimination of the three EWS for predicting calls to physicians by nurses was good (range: 0.87–0.91) for the derivation cohort and moderate (range: 0.71–0.76) for the validation cohort. Equations for probability thresholds of calls to physicians, taking into account the time t, the score at time t and the score at admission, are available.

Conclusion These three EWS developed for children in paediatric wards or emergency departments can be used in PImCU to detect a clinical deterioration and predict the need for medical intervention.

  • child
  • intermediate care units
  • early warning score
  • clinical deterioration
  • peformance

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  • Contributors MEL coordinated and supervised the data collection, drafted the initial manuscript, reviewed and revised the manuscript. AD and HB designed the data collection instruments, carried out the initial analyses and critically reviewed the manuscript for important intellectual content. MR participated sufficiently in the acquisition of data and critically reviewed the manuscript for important intellectual content. SL and FL conceptualised and designed the study, supervised the data collection and critically reviewed the manuscript for important intellectual content.

  • Funding This study was supported by a grant from the French Ministry of Health (PHRC 2011).

  • Competing interests None declared.

  • Ethics approval The study and its database were declared to be safe and approved by the French authorities (Commission Nationale de l’Informatique et des Libertés) (DR-2012–594), and by the SRLF ethics committee (CE-SRLF 12–351).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data from this study are available if necessary.

  • Collaborators Tahar Dhaoui, Veronique Goddefroy, Guillaume Pouessel, Eve Devouge, Dominique Evrard, Florence Delepoulle†, and Sylvie Racoussot.

  • Patient consent for publication Not required.

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