Accuracy of two pediatric early warning scores for clinical deterioration in the brazilian context
Abstract
Objective: To compare the accuracy and reproducibility of the Escore Pediátrico de Alerta (EPA) and the Brazilian version of the Brighton Paediatric Early Warning Score (BPEWS-Br) in the identification of signs of clinical deterioration in the Brazilian context. Methodology: diagnostic test accuracy study, carried out in a large maternal and child hospital, with 240 children and adolescents aged 0 to 15 years, from October 2018 to May 2019. The instruments for collection were the BPEWS, the EPA and the criteria for the primary clinical assessment of critically ill children recommended by the American Heart Association as the reference standard. The data were analyzed using MedCalc® Statistical Software, version 20.007, to estimate indicators of accuracy and agreement between the scores. Results: the EPA ranged from 0 to 7 and the BPEWS-Br from 0 to 8. Considering a score ≥ 3, the EPA had a prevalence of deterioration of 19.5%, the BPEWS-Br of 16.7% and the reference standard of 22.1%. The areas under the ROC curves of the BPEWS-Br and the EPA were practically equal, 93.5% (CI: 90 – 97) and 93.6% (CI: 89.8 – 97.4), respectively, which shows high accuracy of the tests. The Kappa Index between the scores was 0.879 (95% CI: 0.845 to 0.912), showing high agreement. Conclusion: the accuracy and reproducibility indicators of the BPEWS-Br and the EPA were high
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Ball S, Parkinson S, Marjanovic S. Paediatric Early Warning Systems: a scoping study: lessons from a rapid review. Santa Monica, CA: RAND Corporation, 2021. Available from: https://www.rand.org/pubs/research_reports/RRA1105-1.html
Miranda JOF, Camargo CL, Sobrinho CLN, Pinho PS, Oliveira TL. Factors associated with the clinical deterioration recognized by an early warning pediatric score. Texto Contexto Enferm 2020; 29:e20180348. DOI: https://doi.org/10.1590/1980-265X-TCE-2018-0348
Rosman SL, Daneau Briscoe C, Rutare S, McCall N, Monuteaux MC, Unyuzumutima J, et al. (2022) The impact of pediatric early warning score and rapid response algorithm training and implementation on interprofessional collaboration in a resource-limited setting. PLoS ONE 17(6): e0270253. https://doi.org/10.1371/journal.pone.0270253
Monaghan A. Detecting and managing deterioration in children. Paediatr Nurs 2005; 17:32–5. DOI: https://journals.rcni.com//doi/abs/10.7748/paed2005.02.17.1.32.c964
Romaine ST, Sefton G, Lim E, Nijman RG, Bernatoniene J, Clark S et al. Performance of seven different paediatric early warning scores to predict critical care admission in febrile children presenting to the emergency department: a retrospective cohort study. BMJ Open. 2021 May 4;11(5):e044091. DOI: https://doi.org/10.1136/bmjopen-2020-044091
Roland D, Stilwell PA, Fortune PM, John Alexander, J, Clark SJ, Kenny S. Case for change: a standardised inpatient paediatric early warning system in England. Arch Dis Child 2021;106:648–651. DOI: https://doi.org/10.1136/archdischild-2020-320466
Groot JF, Damen N, de Loos E, Van de Steeg L, Koopmans L, Rosias P et al. Implementing paediatric early warning scores systems in the Netherlands: future implications. BMCPediatr. 2018; Apr 6 18(1):128. DOI: https://doi.org/10.1186/s12887-018-1099-6
Oliveira TL, Miranda JO, Sobrinho CL, Mendoza RF, Monaghan AP, Alencar AA. Development and content validation of the Pediatric Alert Score. Rev Soc Bras Enferm Ped 2021; 21(2): 91. DOI: http://dx.doi.org/10.31508/1676-379320210014
Oliveira TL, Miranda JFO, Monaghan AP, Silva RC, Santana AKA, Silva MV, Bessa Junior J et al. Pediatric Alert Score (EPA) performance in clinical deterioration. Acta Paul Enferm 2023;36:eAPE00872. DOI: https://doi.org/10.37689/acta-ape/2023AO00872
Cohen JF, Korevaar DA, Altman DG, Bruns DE, Gatsonis CA, Hooft L et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open. 2016; 6:e012799. DOI: https://doi.org/10.1136/bmjopen-2016-012799
Diaz JA, Werka HMJ, Capp E, Nienov OH. Correlações, risco, razão de chances e avaliação de testes diagnósticos. In: Capp E, Nienov OH. Bioestatística quantitativa aplicada. Porto Alegre: UFRGS, 2020. 177-196 p.
American Heart Association. Abordagem sistemática à criança gravemente doente. In: American Heart Association. Suporte avançado de vida em pediatria manual do profissional. Estados Unidos da América: Orora Visual. 2021. 37-69.
Elencwajg M, Grisolía NA, Meregalli C, Montecuco MA, Montecucoa MA, Montiela MV, Rodríguez, GM et al. Usefulness of an early warning score as an early predictor of clinical deterioration in hospitalized children. Arch Argent Pediatr. 2020; 118(6):399-404. Available from: https://www.sap.org.ar/docs/publicaciones/archivosarg/2020/v118n6a08.pdf
Duraisamy R, Vanaja J, Samy AP, Balasubramaniam B, Palanisamy S. Validation of Brighton pediatric early warning score for predicting clinical deterioration in the emergency department. Indian J Child Health. 2021; June 14. DOI: https://doi.org/10.32677/IJCH.2021.v08.i06.003
Adshead N, Thomson R. Use of a paediatric early warning system in emergency departments. Emerg Nurse. 2009;17(1):22-5. DOI: http://doi.org/10.7748/en2009.04.17.1.22.c6984
Duraisamy R, Balasubramanian B, Palanisamy S. Utility of Pediatric Early Warning Scoring System in Predicting Clinical Deterioration in Children: A Review. SBV Journal of Basic, Clinical and Applied Health Science. 2019; July–September 2(3): 115-118. DOI: https://doi.org/10.5005/jp-journals-10082-02221
Alves VA, Milbrath, VM, Nunes NJS, Gabatz RIB. Segurança do paciente em unidade de terapia intensiva neonatal: revisão integrativa. Ciência, Cuidado E Saúde. 2020. 19. DOI: https://doi.org/10.4025/ciencuidsaude.v19i0.49984
Agulnik A, Malone S, Puerto-Torres M, Gonzalez-Ruiz A, Vedaraju Y, Wang H et al. Reliability and validity of a Spanish-language measure assessing clinical capacity to sustain Paediatric Early Warning Systems (PEWS) in resource-limited hospitals. BMJ Open 2021;11:e053116. DOI: https://doi.org/10.1136/bmjopen-2021-053116
Van Der Fluit KS, Boom MC, Brandao MB, Lopes GD, Barreto PG, Leite DCF, et al.
How to implement a PEWS in a resource-limited setting: A quantitative analysis of the bedside-PEWS implementation in a hospital in northeast Brazil. Trop Med Int Health. 2021;26:1240–1247. https://doi.org/10.1111/tmi.13646
Miranda JO, Camargo CL, Sobrinho CLN, Oliveira TL, Matos AC, Portela DS. Reproducibility and Applicability of a Pediatric Score of Clinical Deterioration Warning. Rev Min Enferm, 2019; 23: 1-6. DOI: https://doi.org/10.5935/1415-2762.20190003
Conselho Regional de Enfermagem de São Paulo. Câmara técnica. Competência para aplicação e avaliação de escalas, escores e índices pediátricos na equipe de enfermagem. Parecer Coren-SP Nº 009/2021. Available from: https://portal.coren-sp.gov.br/wp-content/uploads/2021/04/Parecer_009_2021_Competencia-aplicacao-avaliacao-de-escalas-escores-indices-pediatricos.pdf
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