The Effect of Pediatric Early Warning Score Application for on Mortality in Hospitalized Pediatric Patients

Abstract

We reviewed all medical record of pediatric patient in the hospital from October 2015 to September
2019. The results of medical record review revealed a high mortality rate (86%) in pediatric cardiac
arrest. Consequently, we developed new PEWS (Pediatric Early Warning Signs Score) application for
alert system and automatic calculate of PEWS scoring with an aim to make available a PEWS application
for early detection of pediatric warning signs, ultimately reduce in hospital mortality. The objectives of this
study were to determine the effect of the PEWS application on mortality in hospitalized pediatric patients
and to compare the effectiveness of PEWS application to traditional paper-based PEWS. We conducted an
observational analytical cohort study, which was approved for research by ethics committees of Phaholpolpayuhasena
hospital. The study populations included all hospitalized pediatric patients (age 1 month to
15 years-old) in pediatric ward from March to April 30, 2021. Excluded populations were cases with
incomplete data for calculating PEWS. Data on mortality and the effectiveness of PEWS were obtained
from the hospital database through manual medical record reviews. Of the 62 pediatric patients who
met the inclusion criteria, 31 patients were categorized in the control group for traditional paper-based
PEWS and 31 patients were in the study group for PEWS application. Both groups had the same baseline
clinical characteristics. The study results showed a mortality rate 3.2% (1 in 31 patients), unplanned
ICU admission rate 12.9% (4 in 31 patients) and deterioration rate 9.7% (3 in 31 patients) in the
control group. While there was no death in the study group, no patient transferred to ICU, and no
deteriorated patient. The mean time to response occurred during 80 minutes in control group and 29
minutes in study group. In conclusions, the implementation of PEWS application decreased the mortality
rate, unplanned ICU, deterioration rate and time to response in hospitalized pediatric patients.