Do paediatric early warning scores relate to emergency department outcomes for children aged 0-2 years brought in by ambulance?

Introduction: Ambulance service policy requires paramedics in certain parts of the UK to transport children aged 0-2 years to hospital, regardless of their presenting complaint. While there are a number of paediatric early warning scores (PEWS) that exist to detect deterioration in the hospitalised child, no study has considered the potential relationship between a PEWS recorded by the ambulance service and emergency department (ED) outcome. This study aims to evaluate and understand the potential utility of PEWS in an ambulance service setting.

Methods: A retrospective analysis of patient reports was undertaken, using data from the London Ambulance Service (LAS) and St Mary's Hospital, Paddington, collected over a 12-month period (June 2013 to June 2014). PEWS were calculated using LAS vital signs and compared against ED discharge outcomes.

Results: From a randomised sample of 300 patient records, 169 were included in the final analysis. A total of 100/169 (59.2%) were discharged to home, 30 (17.8%) referred to their GP and 18 (10.7%) were admitted following assessment in the ED. A total of 87/169 had a PEWS of 1, with the vast majority of PEWS 1 (n = 64) resulting in discharge to home. showed low sensitivity (6.8-10.12%) across all scores. Specificity was high for lower scores, but positive predictive values (PPV) were low. also demonstrated low sensitivity (15.53-18.12%) but with higher specificity across all scores. PPV was high for scores > 2 and a PEWS of 2. showed higher sensitivity and specificity than other outcomes, with a PEWS of 2 demonstrating high sensitivity (61.07%), specificity (55.0%) and the PPV was 90%.

Conclusion: PEWS demonstrated high specificity, but poor sensitivity in all outcome measures. As a potential diagnostic test to predict ED outcome, in this study PEWS performed poorly. Further work is required to determine the utility of PEWS, or other early warning scores, for use in an out-of-hospital setting.