New early warning system can predict life-threatening events in hospitalized children

05/23/04

ORLANDO, Fla.--A new early warning system can identify hospitalized children who are at risk of suffering from a life-threatening event such as heart stoppage, abnormal heart rhythm or severe bleeding, according to a study to be presented at the American Thoracic Society International Conference on May 24.

The system, known as the Pediatric Early Warning System, or PEWS, measures a number of vital signs including heart rate, breathing rate, blood pressure and the amount of oxygen in the blood. "Previous studies of adults have shown that an early warning system based on these signs can identify the patients who deteriorate, predict the need for more intensive therapy, and prevent deaths," said lead researcher Heather Duncan, M.D., consultant pediatric intensivist at Birmingham Children's Hospital in Birmingham, UK. "This is the first study that shows that early identification can be used to predict life-threatening events in children."

Dr. Duncan, who conducted the study while at the Hospital for Sick Children in Toronto, Canada, calculated the PEWS score for 35 children who had a life-threatening event while in the hospital, and compared them with scores for 36 children in the hospital who did not suffer a life-threatening event. She found that PEWS can identify children at risk of deterioration and a life-threatening or "Code Blue" event between 1 to 4 hours prior to the event.

"A number of things can lead to cardiac arrest or other life-threatening event in children in the hospital, including infections, heart failure and lack of adequate oxygen," Dr. Duncan said. "The PEWS score will likely go higher and higher as a child's vital signs become more abnormal, and this alerts the nurse to the child's deterioration."

Experienced nurses often can tell that a child is deteriorating, but currently there is no objective tool that less experienced nurses can use to pick up on subtle changes before they turn into a life-threatening event, Dr. Duncan said.

Once a child is identified as being at risk of a life-threatening event, doctors try to determine the cause, and based on that information, determine how to best treat the child, she said.

Source: Eurekalert & others

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