• Claus Sixtus Jensen, Olesen Hanne Vebert HV Department of Child and Adolescent Health, Aarhus University Hospital, Aarhus N, Denmark. Electronic address: hannoles@rm.dk., Hanne Aagaard, Marie Louise Overgaard Svendsen, and Hans Kirkegaard.
• Research Centre for Emergency Medicine, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark; Department of Paediatrics and Adolescent Medicine, Herlev Gentofte University Hospital, Herlev, Denmark. Electronic address: claus.sixtus@skejby.rm.dk.
• J Pediatr Nurs. 2019 Jan 1; 44: e58-e65.

PurposePediatric early warning systems (PEWS) are used to detect clinical deterioration in hospitalized children. Few PEWSs have been validated in multicenter studies and the performance in many single-center studies varies. We wanted to compare two PEWS in a multicenter study.Design And MethodsRandomized multicenter unblinded trial conducted at all pediatric departments in the Central Denmark Region. A random sample of 16,213 pediatric patients (31,337 admissions) were enrolled from November 2014 to March 2017. Patients were randomized to The Bedside PEWS or CDR PEWS. The primary outcome was the sum of hospitalized children experiencing in-hospital clinical deterioration requiring transfer to a higher level of care.ResultsOf the 21,077 pediatric patients who met the inclusion criteria, 16,213 (from 31,337 admissions) were enrolled. 22 unplanned transfers to a higher level of care were identified: 14 in The Bedside PEWS group and 8 in the CDR PEWS group, a non-statistical difference (P = 0.20). No significant difference in predicting unplanned transfer to a higher level of care (P = 0.78) were detected and no significant difference was observed in the secondary outcomes.ConclusionsThe CDR PEWS prevents as many critical events as The Bedside PEWS. Shorter median time to PEWS reassessment when CDR PEWS was used and fewer reassessments being done to late could reflect that the CDR PEWS was more acceptable to staff.Practice ImplicationsThe results from this study should be interpreted with caution as very few patients experiencing clinical deterioration and further studies should also focus on challenges trying to evaluate PEWS.Copyright © 2018 Elsevier Inc. All rights reserved.

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