Inaccurate Recording of Pediatric Early Warning Score Associated with Clinical Outcomes: An Experience from a Developing Country

Ditya Divale Rinenggo; Firdian Makrufardi; Titis Widowati; Intan Fatah Kumara; Nurnaningsih Nurnaningsih; Desy Rusmawatiningtyas

doi:10.3889/oamjms.2023.11553

Authors

Ditya Divale Rinenggo Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
Firdian Makrufardi Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia; International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan https://orcid.org/0000-0001-5376-5478
Titis Widowati Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
Intan Fatah Kumara Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
Nurnaningsih Nurnaningsih Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
Desy Rusmawatiningtyas Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2023.11553

Keywords:

Intensive care, Outcomes, Pediatric, Pediatric early warning score, Unplanned admission

Abstract

BACKGROUND: The pediatric early warning score (PEWS) can assist in the identification of patients on wards who are at risk of deterioration.

AIM: This study was aimed to examine the accuracy of PEWS recording and its association with clinical outcomes in a tertiary hospital.

METHODS: A retrospective and case-controlled study was conducted on participants aged 1 month – 18 years admitted emergently from the ward to the pediatric intensive care unit (PICU) due to clinical deterioration between January and December 2021. The documented PEWS score was obtained from medical records, while the corrected PEWS score was calculated from the patients’ clinical data at the same time the documented PEWS score recorded.

RESULTS: Total 70 patients who met the inclusion criteria were included for analysis. We observed about 38 patients (54.3%) had PEWS errors. We also observed significant difference in the respiratory and gastroenterology diagnosis categories between the PEWS error group and non-PEWS error group. The mean documented PEWS score at PICU admission was lower in PEWS error patients compared to non-PEWS error patients (1.34 ± 1.28 versus 4.31 ± 2.73, respectively, p < 0.05). The need for vasoactive drugs was significantly higher at 72 h after PICU admission and at PICU discharge for the patients in PEWS errors group (p < 0.05). PEWS errors group were associated with higher need for vasoactive drugs (RR = 2.01; 95% CI: 1.22–3.31; p < 0.05).

CONCLUSION: Inaccurate recording of PEWS caused earlier and higher need for vasoactive drugs in patients with unplanned PICU admission. We highlighted the importance of PEWS in the clinical outcome of pediatric patients.

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