Validation of the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in low- and middle-income countries: A multicentre observational study.
Early recognition of children at risk of serious illness is essential in preventing morbidity and mortality, particularly in low- and middle-income countries (LMICs). This study aimed to validate the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in acute care settings in LMIC...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2024-01-01
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| Series: | PLOS Global Public Health |
| Online Access: | https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0002716&type=printable |
| _version_ | 1827308768700923904 |
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| author | Naomi Kemps Natanael Holband Navin P Boeddha Abdoulie Faal Amadu E Juliana Godfrey A Kavishe Kristina Keitel Kevin H van 't Kruys Elizabeth V Ledger Henriëtte A Moll Andrew M Prentice Fatou Secka Rainer Tan Effua Usuf Stefan A Unger Joany M Zachariasse VITaLs (VItal signs and Triage in Low- and middle income countries) study group |
| author_facet | Naomi Kemps Natanael Holband Navin P Boeddha Abdoulie Faal Amadu E Juliana Godfrey A Kavishe Kristina Keitel Kevin H van 't Kruys Elizabeth V Ledger Henriëtte A Moll Andrew M Prentice Fatou Secka Rainer Tan Effua Usuf Stefan A Unger Joany M Zachariasse VITaLs (VItal signs and Triage in Low- and middle income countries) study group |
| author_sort | Naomi Kemps |
| collection | DOAJ |
| description | Early recognition of children at risk of serious illness is essential in preventing morbidity and mortality, particularly in low- and middle-income countries (LMICs). This study aimed to validate the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in acute care settings in LMICs. This observational study is based on previously collected clinical data from consecutive children attending four diverse settings in LMICs. Inclusion criteria and study periods (2010-2021) varied. We simulated the ED-PEWS, consisting of patient age, consciousness, work of breathing, respiratory rate, oxygen saturation, heart rate, and capillary refill time, based on the first available parameters. Discrimination was assessed by the area under the curve (AUC), sensitivity and specificity (previously defined cut-offs < 6 and ≥ 15). The outcome measure was for each setting a composite marker of high urgency. 41,917 visits from Gambia rural, 501 visits from Gambia urban, 2,608 visits from Suriname, and 1,682 visits from Tanzania were included. The proportion of high urgency was variable (range 4.6% to 24.9%). Performance ranged from AUC 0.80 (95%CI 0.70-0.89) in Gambia urban to 0.62 (95%CI 0.55-0.67) in Tanzania. The low-urgency cut-off showed a high sensitivity in all settings ranging from 0.83 (95%CI 0.81-0.84) to 1.00 (95%CI 0.97-1.00). The high-urgency cut-off showed a specificity ranging from 0.71 (95%CI 0.66-0.75) to 0.97 (95%CI 0.97-0.97). The ED-PEWS has a moderate to good performance for the recognition of high urgency children in these LMIC settings. The performance appears to have potential in improving the identification of high urgency children in LMICs. |
| first_indexed | 2024-04-24T19:16:43Z |
| format | Article |
| id | doaj.art-beb06151961e41f0ab64b8cfc4ff3f06 |
| institution | Directory Open Access Journal |
| issn | 2767-3375 |
| language | English |
| last_indexed | 2024-04-24T19:16:43Z |
| publishDate | 2024-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLOS Global Public Health |
| spelling | doaj.art-beb06151961e41f0ab64b8cfc4ff3f062024-03-26T06:06:23ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752024-01-0143e000271610.1371/journal.pgph.0002716Validation of the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in low- and middle-income countries: A multicentre observational study.Naomi KempsNatanael HolbandNavin P BoeddhaAbdoulie FaalAmadu E JulianaGodfrey A KavisheKristina KeitelKevin H van 't KruysElizabeth V LedgerHenriëtte A MollAndrew M PrenticeFatou SeckaRainer TanEffua UsufStefan A UngerJoany M ZachariasseVITaLs (VItal signs and Triage in Low- and middle income countries) study groupEarly recognition of children at risk of serious illness is essential in preventing morbidity and mortality, particularly in low- and middle-income countries (LMICs). This study aimed to validate the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in acute care settings in LMICs. This observational study is based on previously collected clinical data from consecutive children attending four diverse settings in LMICs. Inclusion criteria and study periods (2010-2021) varied. We simulated the ED-PEWS, consisting of patient age, consciousness, work of breathing, respiratory rate, oxygen saturation, heart rate, and capillary refill time, based on the first available parameters. Discrimination was assessed by the area under the curve (AUC), sensitivity and specificity (previously defined cut-offs < 6 and ≥ 15). The outcome measure was for each setting a composite marker of high urgency. 41,917 visits from Gambia rural, 501 visits from Gambia urban, 2,608 visits from Suriname, and 1,682 visits from Tanzania were included. The proportion of high urgency was variable (range 4.6% to 24.9%). Performance ranged from AUC 0.80 (95%CI 0.70-0.89) in Gambia urban to 0.62 (95%CI 0.55-0.67) in Tanzania. The low-urgency cut-off showed a high sensitivity in all settings ranging from 0.83 (95%CI 0.81-0.84) to 1.00 (95%CI 0.97-1.00). The high-urgency cut-off showed a specificity ranging from 0.71 (95%CI 0.66-0.75) to 0.97 (95%CI 0.97-0.97). The ED-PEWS has a moderate to good performance for the recognition of high urgency children in these LMIC settings. The performance appears to have potential in improving the identification of high urgency children in LMICs.https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0002716&type=printable |
| spellingShingle | Naomi Kemps Natanael Holband Navin P Boeddha Abdoulie Faal Amadu E Juliana Godfrey A Kavishe Kristina Keitel Kevin H van 't Kruys Elizabeth V Ledger Henriëtte A Moll Andrew M Prentice Fatou Secka Rainer Tan Effua Usuf Stefan A Unger Joany M Zachariasse VITaLs (VItal signs and Triage in Low- and middle income countries) study group Validation of the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in low- and middle-income countries: A multicentre observational study. PLOS Global Public Health |
| title | Validation of the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in low- and middle-income countries: A multicentre observational study. |
| title_full | Validation of the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in low- and middle-income countries: A multicentre observational study. |
| title_fullStr | Validation of the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in low- and middle-income countries: A multicentre observational study. |
| title_full_unstemmed | Validation of the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in low- and middle-income countries: A multicentre observational study. |
| title_short | Validation of the Emergency Department-Paediatric Early Warning Score (ED-PEWS) for use in low- and middle-income countries: A multicentre observational study. |
| title_sort | validation of the emergency department paediatric early warning score ed pews for use in low and middle income countries a multicentre observational study |
| url | https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0002716&type=printable |
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