Joany M Zachariasse1, Daan Nieboer2, Ian K Maconochie3, Frank J Smit4, Claudio F Alves5, Susanne Greber-Platzer6, Maria N Tsolia7, Ewout W Steyerberg8, Paul Avillach9, Johan van der Lei10, Henriëtte A Moll11. 1. Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands. 2. Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands. 3. Department of Paediatric Emergency Medicine, Imperial College NHS Healthcare Trust, London, UK. 4. Department of Paediatrics, Maasstad Hospital, Rotterdam, Netherlands. 5. Department of Paediatrics, Emergency Unit, Hospital Professor Doutor Fernando da Fonseca, Lisbon, Portugal. 6. Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria. 7. National and Kapodistrian University of Athens, Second Department of Paediatrics, P and A Kyriakou Children's Hospital, Athens, Greece. 8. Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands. 9. Department of Medical Informatics, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands; Harvard Medical School, Department of Biomedical Informatics, Boston, MA, USA. 10. Department of Medical Informatics, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands. 11. Department of General Paediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands. Electronic address: h.a.moll@erasmusmc.nl.
Abstract
BACKGROUND: Paediatric Early Warning Scores (PEWSs) are being used increasingly in hospital wards to identify children at risk of clinical deterioration, but few scores exist that were designed for use in emergency care settings. To improve the prioritisation of children in the emergency department (ED), we developed and validated an ED-PEWS. METHODS: The TrIAGE project is a prospective European observational study based on electronic health record data collected between Jan 1, 2012, and Nov 1, 2015, from five diverse EDs in four European countries (Netherlands, the UK, Austria, and Portugal). This study included data from all consecutive ED visits of children under age 16 years. The main outcome measure was a three-category reference standard (high, intermediate, low urgency) that was developed as part of the TrIAGE project as a proxy for true patient urgency. The ED-PEWS was developed based on an ordinal logistic regression model, with cross-validation by setting. After completing the study, we fully externally validated the ED-PEWS in an independent cohort of febrile children from a different ED (Greece). FINDINGS: Of 119 209 children, 2007 (1·7%) were of high urgency and 29 127 (24·4%) of intermediate urgency, according to our reference standard. We developed an ED-PEWS consisting of age and the predictors heart rate, respiratory rate, oxygen saturation, consciousness, capillary refill time, and work of breathing. The ED-PEWS showed a cross-validated c-statistic of 0·86 (95% prediction interval 0·82-0·90) for high-urgency patients and 0·67 (0·61-0·73) for high-urgency or intermediate-urgency patients. A cutoff of score of at least 15 was useful for identifying high-urgency patients with a specificity of 0·90 (95% CI 0·87-0·92) while a cutoff score of less than 6 was useful for identifying low-urgency patients with a sensitivity of 0·83 (0·81-0·85). INTERPRETATION: The proposed ED-PEWS can assist in identifying high-urgency and low-urgency patients in the ED, and improves prioritisation compared with existing PEWSs. FUNDING: Stichting de Drie Lichten, Stichting Sophia Kinderziekenhuis Fonds, and the European Union's Horizon 2020 research and innovation programme.
BACKGROUND: Paediatric Early Warning Scores (PEWSs) are being used increasingly in hospital wards to identify children at risk of clinical deterioration, but few scores exist that were designed for use in emergency care settings. To improve the prioritisation of children in the emergency department (ED), we developed and validated an ED-PEWS. METHODS: The TrIAGE project is a prospective European observational study based on electronic health record data collected between Jan 1, 2012, and Nov 1, 2015, from five diverse EDs in four European countries (Netherlands, the UK, Austria, and Portugal). This study included data from all consecutive ED visits of children under age 16 years. The main outcome measure was a three-category reference standard (high, intermediate, low urgency) that was developed as part of the TrIAGE project as a proxy for true patient urgency. The ED-PEWS was developed based on an ordinal logistic regression model, with cross-validation by setting. After completing the study, we fully externally validated the ED-PEWS in an independent cohort of febrile children from a different ED (Greece). FINDINGS: Of 119 209 children, 2007 (1·7%) were of high urgency and 29 127 (24·4%) of intermediate urgency, according to our reference standard. We developed an ED-PEWS consisting of age and the predictors heart rate, respiratory rate, oxygen saturation, consciousness, capillary refill time, and work of breathing. The ED-PEWS showed a cross-validated c-statistic of 0·86 (95% prediction interval 0·82-0·90) for high-urgency patients and 0·67 (0·61-0·73) for high-urgency or intermediate-urgency patients. A cutoff of score of at least 15 was useful for identifying high-urgency patients with a specificity of 0·90 (95% CI 0·87-0·92) while a cutoff score of less than 6 was useful for identifying low-urgency patients with a sensitivity of 0·83 (0·81-0·85). INTERPRETATION: The proposed ED-PEWS can assist in identifying high-urgency and low-urgency patients in the ED, and improves prioritisation compared with existing PEWSs. FUNDING: Stichting de Drie Lichten, Stichting Sophia Kinderziekenhuis Fonds, and the European Union's Horizon 2020 research and innovation programme.
Authors: Gina Schinkelshoek; Dorine M Borensztajn; Joany M Zachariasse; Ian K Maconochie; Claudio F Alves; Paulo Freitas; Frank J Smit; Johan van der Lei; Ewout W Steyerberg; Susanne Greber-Platzer; Henriëtte A Moll Journal: BMJ Paediatr Open Date: 2020-09-15
Authors: Joany M Zachariasse; Ian K Maconochie; Ruud G Nijman; Susanne Greber-Platzer; Frank J Smit; Daan Nieboer; Johan van der Lei; Claudio F Alves; Henriëtte A Moll Journal: PLoS One Date: 2021-02-09 Impact factor: 3.240
Authors: Dorine M Borensztajn; Nienke N Hagedoorn; Irene Rivero Calle; Ian K Maconochie; Ulrich von Both; Enitan D Carrol; Juan Emmanuel Dewez; Marieke Emonts; Michiel van der Flier; Ronald de Groot; Jethro Herberg; Benno Kohlmaier; Emma Lim; Federico Martinon-Torres; Daan Nieboer; Ruud G Nijman; Marko Pokorn; Franc Strle; Maria Tsolia; Clementien Vermont; Shunmay Yeung; Dace Zavadska; Werner Zenz; Michael Levin; Henriette A Moll Journal: PLoS One Date: 2021-01-07 Impact factor: 3.240
Authors: Shu-Ling Chong; Mark Sen Liang Goh; Gene Yong-Kwang Ong; Jason Acworth; Rehena Sultana; Sarah Hui Wen Yao; Kee Chong Ng Journal: Resusc Plus Date: 2022-06-29
Authors: Dorine M Borensztajn; Nienke N Hagedoorn; Enitan D Carrol; Ulrich von Both; Marieke Emonts; Michiel van der Flier; Ronald de Groot; Jethro Herberg; Benno Kohlmaier; Michael Levin; Emma Lim; Ian K Maconochie; Federico Martinon-Torres; Ruud G Nijman; Marko Pokorn; Irene Rivero-Calle; Maria Tsolia; Fabian J S van der Velden; Clementien Vermont; Dace Zavadska; Werner Zenz; Joany M Zachariasse; Henriette A Moll Journal: Eur J Pediatr Date: 2022-07-07 Impact factor: 3.860