臨床小児科: オープンアクセス
オープンアクセス

概要

Rapid Transfer to the Pediatric Intensive Care Unit after Admission from the Emergency Department: Role of the Pediatric Early Warning Score

Erica Del Grippo, Kimberly McMahon, Christopher Plymire, Andrew DePiero

Background: Admission decisions in the emergency department (ED) can be challenging. Admitting a patient to a general inpatient unit who then quickly requires transfer to an intensive care unit (ICU) generates stress and safety concerns for staff, patient and family. Objective: Our study sought to identify predictors via the PEWS at the time of admission from the ED of patients likely to require rapid transfer to the ICU. Pediatric Early Warning Scores (PEWS) can predict patients at risk for clinical deterioration. We hypothesized that PEWS obtained prior to admission could be predictive of need for transfer, and that PEWS would increase in patients requiring ICU transfer. Design/Methods: We retrospectively reviewed charts of patients requiring transfer to the ICU within 10 hours of admission. 73 case patients were identified, control patients were matched by age and diagnosis and PEWS were calculated. Scores were compared between the case and control groups. Results: The PEWS for case patients in the ED were higher than those for controls (p=0.026). PEWS on admission remained higher for cases than controls. On transfer to the ICU, PEWS for the case group had increased to a median of 4 with IQR of 5. Conclusion: This review demonstrates that elevated PEWS do correlate with need for ICU transfer, however, the level of the score is less than might be expected. With patients requiring rapid transfer to the ICU having a median PEWS of only 2 in the ED, it is likely not practical to use this as a tool to request ICU evaluation while still in the ED.