Escalation of care in children at high risk of clinical deterioration in a tertiary care children’s hospital using the Bedside Pediatric Early Warning System

Autor: Orsola Gawronski, Jos Maria Latour, Corrado Cecchetti, Angela Iula, Lucilla Ravà, Marta Luisa Ciofi degli Atti, Immacolata Dall’Oglio, Emanuela Tiozzo, Massimiliano Raponi, Christopher S. Parshuram
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: BMC Pediatrics, Vol 22, Iss 1, Pp 1-11 (2022)
Druh dokumentu: article
ISSN: 1471-2431
DOI: 10.1186/s12887-022-03555-0
Popis: Abstract Background Escalation and de-escalation are a routine part of high-quality care that should be matched with clinical needs. The aim of this study was to describe escalation of care in relation to the occurrence and timing of Pediatric Intensive Care Unit (PICU) admission in a cohort of pediatric inpatients with acute worsening of their clinical condition. Methods A monocentric, observational cohort study was performed from January to December 2018. Eligible patients were children: 1) admitted to one of the inpatient wards other than ICU; 2) under the age of 18 years at the time of admission; 3) with two or more Bedside-Paediatric-Early-Warning-System (BedsidePEWS) scores ≥ 7 recorded at a distance of at least one hour and for a period of 4 h during admission. The main outcome -the 24-h disposition – was defined as admission to PICU within 24-h of enrolment or staying in the inpatient ward. Escalation of care was measured using an eight-point scale—the Escalation Index (EI), developed by the authors. The EI was calculated every 6 h, starting from the moment the patient was considered eligible. Analyses used multivariate quantile and logistic regression models. Results The 228 episodes included 574 EI calculated scores. The 24-h disposition was the ward in 129 (57%) and the PICU in 99 (43%) episodes. Patients who were admitted to PICU within 24-h had higher top EI scores [median (IQR) 6 (5–7) vs 4 (3–5), p
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