Pediatric Early Warning Score (PEWS) in predicting prognosis of critical pediatric trauma patients: a retrospective study
Pediatric Early Warning Score (PEWS) na previsão do prognóstico de pacientes pediátricos com trauma crítico: um estudo retrospectivo
Abdulrahman Özel, Ulkem Kocoglu Barlas, Servet Yüce, Cansu Günerhan, Meltem Erol
Abstract
Background
This study aimed to compare the predictive value of Pediatric Early Warning Score (PEWS) to Pediatric Risk of Mortality-3 (PRISM-3), Pediatric Trauma Score (PTS), and Pediatric Glasgow Coma Score (pGCS) in determining clinical severity and mortality among critical pediatric trauma patients.
Method
A total of 122 patients monitored due to trauma in the pediatric intensive care unit between 2020 and 2023 were included in the study. Physical examination findings, vital parameters, laboratory values, and all scoring calculations for patients during emergency room admissions and on the first day of intensive care follow-up were recorded. Comparisons were made between two groups identified as survivors and non-survivors.
Results
The study included 85 (69.7%) male and 37 (30.3%) female patients, with an average age of 75 ± 59 months for all patients. Forty-one patients (33.6%) required Invasive Mechanical Ventilation (IMV) and 11 patients (9%) required inotropic therapy. Logistic regression analysis revealed a significant association between mortality and PEWS (p < 0.001), PRISM-3 (p < 0.001), PTS (p < 0.001), and pGCS (p < 0.001). Receiver operating characteristics curve analysis demonstrated that the PEWS score (cutoff > 6.5, AUC = 0.953, 95% CI 0.912–0.994) was highly predictive of mortality, showing similar performance to the PRISM-3 score (cutoff > 21, AUC = 0.999, 95% CI 0.995–1). Additionally, the PEWS score was found to be highly predictive in forecasting the need for IMV and inotropic therapy.
Conclusion
The Pediatric Early Warning Score serves as a robust determinant of mortality in critical pediatric trauma patients. Simultaneously, it demonstrates strong predictability in anticipating the need for IMV and inotropic therapy.
Keywords
Resumo
Introdução
Este estudo teve como objetivo comparar o valor preditivo do Pediatric Early Warning Score (PEWS) com o Pediatric Risk of Mortality-3 (PRISM-3), o Pediatric Trauma Score (PTS) e o Pediatric Glasgow Coma Score (pGCS) na determinação da gravidade clínica. e mortalidade entre pacientes pediátricos críticos com trauma.
Métodos
Foram incluídos no estudo 122 pacientes acompanhados por trauma na unidade de terapia intensiva pediátrica entre 2020 e 2023. Foram registrados os achados do exame físico, parâmetros vitais, valores laboratoriais e todos os cálculos de pontuação dos pacientes durante as admissões no pronto-socorro e no primeiro dia de acompanhamento na terapia intensiva. Comparações foram feitas entre dois grupos identificados como sobreviventes e não sobreviventes.
Resultados
O estudo incluiu 85 (69,7%) pacientes do sexo masculino e 37 (30,3%) do sexo feminino, com idade média de 75±59 meses para todos os pacientes. Quarenta e um pacientes (33,6%) necessitaram de ventilação mecânica invasiva (VMI) e 11 pacientes (9%) necessitaram de terapia inotrópica. A análise de regressão logística revelou associação significativa entre mortalidade e PEWS (p < 0,001), PRISM-3 (p < 0,001), PTS (p < 0,001) e pGCS (p < 0,001). A análise da curva de características operacionais do receptor demonstrou que o escore PEWS (ponto de corte > 6,5, AUC: 0,953, IC 95%: 0,912–0,994) foi altamente preditivo de mortalidade, apresentando desempenho semelhante ao escore PRISM-3 (ponto de corte > 21, AUC: 0,999). , IC 95%: 0,995–1). Além disso, o escore PEWS foi considerado altamente preditivo na previsão da necessidade de VMI e terapia inotrópica.
Conclusão
O Pediatric Early Warning Score serve como um determinante robusto de mortalidade em pacientes pediátricos críticos com trauma. Simultaneamente, demonstra forte previsibilidade na antecipação da necessidade de VMI e terapia inotrópica.
Palavras-chave
Referencias
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Submitted date:
05/02/2024
Accepted date:
04/07/2024
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