. Early warning scores for clinical deterioration in pediatric patients: a literature review.
Introduction: An early recognition of clinical worsening (the manifestation of signs and symptoms resulting in physiological instability) in pediatric inpatients may prevent the evolution towards cardiorespiratory arrest. In recent decades, several tools known as PEWS (Pediatric Early Warning Scores), have been developed, aiming to reduce in-hospital morbidity and mortality.
Objective: To describe efficacy, sensitivity and specificity of the available tools for early detection of clinical worsening in children, based on literature review.
Methods: Systematic review through the consultation of PubMed and Google Scholar, cross-combining Mesh terms and free text words.
Results: Out of 266 analysed papers, 34 were included in this review: 23 retrospective observational studies, 8 reviews, 1 reliability study, and 2 pilot studies. Overall, 23 main PEWS with sufficient evidence of efficacy were described (11 track and trigger and 12 aggregate). Ranges of sensibility and specificity were available only for 18 PEWS. It is not possible to recognize a gold standard, however, some PEWS are better in terms of validity and efficacy in different clinical settings. Internationally, the BPEWS (Brighton Pediatric Early Warning Score) is the most commonly adopted tool, able to identify clinical worsening of in-hospital children almost 11 hours before cardiac arrest.
Conclusions: Although with limited evidence, validated PEWS have shown good ability to prevent the risk of clinical worsening by reducing adverse events. Further studies and greater standardization according to the clinical context are still needed.