ArticleEuropean journal of pediatrics2019
Risk stratification to improve Pediatric Early Warning Systems: it is all about the context.
Article in European journal of pediatrics, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Automated Features, Algorithms, and Technologies of Electronic Early Warning/Track-and-Trigger Systems: Systematic Review.Journal of medical Internet research · 2026Pooled it
- Sedation reversal trends at outpatient ambulatory endoscopic centerWorld journal of gastrointestinal endoscopy · 2024Trial
- Implementation of a PEWS-integrated electronic SBAR handover model for pediatric inpatients: A nonconcurrent controlled study.Medicine · 2026Article
- Performance of the Dutch Pediatric Early Warning Score: a nationwide study in academic, large teaching and general hospital contexts, using real-world data.BMJ paediatrics open · 2026Article
- Short-term risk stratification using parallel admission and reassessment features in PICU patients with infection.Frontiers in pediatrics · 2026Article
- Management of acute pyelonephritis in pregnancy in emergency settings: A comparative study of conservative therapy and renal drainage.Journal of education and health promotion · 2026Article
- Pediatric Early Warning Score in interhospital ambulance care: a pilot study exploring feasibility and impact.Scandinavian journal of trauma, resuscitation and emergency medicine · 2025Article
- Pediatric early warning score and unplanned readmission with influenza at emergency observation room.Frontiers in pediatrics · 2025Article
- A crisis awareness chain warning management model for patients with difficulties cooperating with magnetic resonance examinations.The Journal of international medical research · 2024Article
- Implementation of a critical care outreach team in a children's hospital.Resuscitation plus · 2024Article
- Study protocol of a national multicentre prospective evaluation study assessing the validity and impact of the Dutch Paediatric Early Warning Score (PEWS) in the Netherlands.BMJ paediatrics open · 2024Article
- Development of the national Dutch PEWS: the challenge against heterogeneity and implementation difficulties of PEWS in the Netherlands.BMC pediatrics · 2023Article
- Accuracy and Monitoring of Pediatric Early Warning Score (PEWS) Scores Prior to Emergent Pediatric Intensive Care Unit (ICU) Transfer: Retrospective Analysis.JMIR pediatrics and parenting · 2021Article
- Overall and subgroup specific performance of the pediatric index of mortality 2 score in Switzerland: a national multicenter study.European journal of pediatrics · 2020Article
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5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Early recognition of critically ill patients is of paramount importance to reduce pediatric mortality and morbidity. We created a risk stratification system combining vital parameters and predefined risk factors aimed at reducing the risk of unrecognized clinical deterioration compared with conventional Pediatric Early Warning Systems (PEWS). This single-center retrospective case cohort study included infants (gestational age ≥ 37 weeks) to adolescents (aged <18 years) with unplanned pediatric intensive care unit (PICU) admission between April 01, 2014, and February 28, 2018. The sensitivity in the 24 h prior to endpoint of the Pediatric Risk Evaluation and Stratification System (PRESS) was compared with that of the conventional PEWS and calculated as the proportion of study patients who received a high-risk score. Seventy-four PICU admissions were included. PRESS and PEWS sensitivities at 2 h prior to endpoint were 0.70 (95%CI 0.59 to 0.80) and 0.30 (95%CI 0.20 to 0.42) respectively (p < 0.001). Excluding patients with seizures, PRESS sensitivity increased to 0.75 (95%CI 0.64 to 0.85). Forty-nine patients (66%) scored positive on at least one high-risk factor, and "worried sign" was scored in 31 patients (42%).Conclusion: Risk stratification seems advantageous for a faster detection of clinical deterioration, providing opportunity for earlier intervention. What is Known: • Prompt detection of clinical deterioration is of essential importance to reduce morbidity and mortality. • Conventional Pediatric Early Warning Systems (PEWS) have limited sensitivity and a short window of detection of 1 to 2 h. What is New: • Risk stratification based on context factors allows earlier identification of patients at risk, well before deviation of vital signs. • Risk stratification combined with continuous monitoring of deteriorating trends in vital signs could lead to the development of next-generation warning systems achieving true patient safety.
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