• Nathan P Dean, J B Fenix, Michael Spaeder, and Amanda Levin.
• 1Division of Critical Care Medicine, Children's National Health System, Washington, DC. 2Division of Critical Care Medicine, George Washington School of Medicine, Washington, DC. 3Department of Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 4Division of Pediatric Critical Care Medicine, University of Virginia School of Medicine, Charlottesville, VA.
• Pediatr Crit Care Me. 2017 Jul 1; 18 (7): 655-660.

ObjectiveTo evaluate the ability of a Pediatric Early Warning Score to predict deterioration in different subspecialty patient populations.DesignSingle center, retrospective cohort study. Patients were classified into five groups: 1) cardiac; 2) hematology/oncology/bone marrow transplant; 3) surgical; 4) neurologic; and 5) general medical. The relationship between the Pediatric Early Warning Score and unplanned ICU transfer requiring initiation of specific ICU therapies (intubation, high-flow nasal cannula, noninvasive ventilation, inotropes, or aggressive fluid hydration within 12 hr of transfer) was evaluated.SettingTertiary care, free-standing, academic children's hospital.PatientsAll hospitalized acute care patients admitted over a 6-month time period (September 2012 to March 2013).InterventionsNone.Measurements And Main ResultsDuring the study time period, 33,800 patient-days and 136 deteriorations were evaluated. Area under the curve ranged from 0.88 (surgical) to 0.94 (cardiac). Sensitivities for a Pediatric Early Warning Score greater than or equal to 3 ranged from 75% (surgical) to 94% (cardiology) and number needed to evaluate to find one deterioration was 11.5 (neurologic) to 43 patients (surgical). Sensitivities for a Pediatric Early Warning Score greater than or equal to 4 ranged from 54% (general medical) to 79% (hematology/oncology/bone marrow transplant) and number needed to evaluate of 5.5 (neurologic) to 12 patients (general medical). Sensitivities for a Pediatric Early Warning Score of greater than or equal to 5 ranged from 25% (surgical) to 58% (hematology/oncology/bone marrow transplant) and number needed to evaluate of 3.5 (cardiac, hematology/oncology/bone marrow transplant, neurologic) to eight patients (surgical).ConclusionsAn elevated Pediatric Early Warning Score is associated with ICU transfer and receipt of ICU-specific interventions in patients across different pediatric subspecialty patient populations.

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