Abstract

Amaç: Pediatrik erken uyarı skoru (PEUS), acil serviste veya klinikte çocukların erken dönemde klinik kötüleşme riskini belirleyerek, kliniği kötüleşecek hastaları erken dönemde fark edip, tedavi planını düzenlemek için geliştirilmiş bir ölçektir. Çalışmanın amacı, PEUS'un Türkçe'ye uyarlanması ve acil hastalarda geçerlilik ve güvenilirliğinin değerlendirilmesidir. Gereç ve Yöntemler: Bu çalışma Mayıs-Ekim 2022 tarihleri arasında, üçüncü basamak bir hastanenin pediatrik acil servisinde 17 yaş ve altı 228 hastada gerçekleştirilmiştir. Çalışmanın pilot aşamasında acil serviste üç hemşire tarafından ilk 30 hastanın skorlaması yapılmıştır. İkinci aşamada, PEUS ölçeğinin geçerliliği değerlendirilmiştir. Skorlamanın kabul edilebilirlik düzeyi, işlem karakteristik (ROC) eğrisi ve ROC eğrisi altında kalan alan (AUC), duyarlılık, özgüllük, pozitif tahmin değeri (PPV) ve negatif tahmin değeri (NPV) kullanılarak değerlendirilmiştir. Bulgular: Çalışmaya yaş ortalaması 6,37 ± 4,72 yıl olan 129'u (%56,57) erkek, toplam 228 hasta alınmıştır. Faz I, iyi bir gözlemci arası güvenirlik göstermiştir (kappa = 0,75). Faz II'de, çalışma dönemi boyunca 22 (%9,6) hasta yoğun bakım ünitesine (YBÜ) kabul edilmiştir. Tahminleme için AUC değeri 0,948 (95% CI: 0,915-0,981) olarak bulunmuştur. ROC eğrisi analizine göre, YBÜ'ye kabul edilenler için PEUS skoru kesim değeri 4 olarak bulunmuştur (PEUS ≥4). PEUS ≥4 kesim değeriyle YBÜ kabulünü tahmin etmede hassasiyet ve özgüllük değerleri sırasıyla %86,36 ve %90,78 idi (PPV: %50, NPV: %90,48). PEUS ≥1 kesim değeriyle kabulü tahmin etmede hassasiyet ve özgüllük sırasıyla %100 ve %59,22 idi (PPV: %20,75, NPV: %100). Tartışma: PEUS Türkçe versiyonu kabul edilebilir geçerlilikle, pediatrik acil serviste hastanın durumunu değerlendirmeye yardımcı olabilir ve erken klinik veya YBÜ kabulünü tahmin etmek için tarama aracı olarak kullanılabilir.

Keywords

• Çocuklar
• acil servis
• PEWS
• güvenilirlik
• geçerlilik

Validation of the Turkish version of the pediatric early warning score

Abstract

Aim: The pediatric early warning score (PEWS) identifies pediatric patients at risk for clinical deterioration and can helpless-experienced providers get a sense of which patients may need escalation of care. The purpose of the study was to adapt the PEWS into Turkish and evaluate its validity in pediatric patients admitted to the emergency. Material and Methods: This study was conducted between May and October 2022 on 228 patients aged 17 and under in the pediatric emergency department of a tertiary care hospital. In the pilot phase of the study, scoring of the first 30 patients was performed by three nurses in the emergency department. In the second phase, the validity of the PEWS scale was evaluated. Validity of the scoring system in predicting admission was assessed using area under the receiver operating characteristics (ROC) curve (AUC), sensitivity, and specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: The mean age of the children was 6.37 ± 4.72 years. Phase I demonstrated good inter-rater reliability (kappa = 0.75). In phase II, 22 patients (9.6%) were admitted to the intensive care unit (ICU) during the study period. AUC for predicting was 0.948 (95% CI: 0.915–0.981). According to ROC curve analysis, a cut-off value for PEWS score was found to be 4 (PEWS >4) for admitted to the ICU. Sensitivity and specificity in predicting ICU admission with the cut-off PEWS ≥4 was 86.36% and 90.78%, respectively (PPV, 50%; NPV, 90.48%). The sensitivity and specificity in predicting admission with a cut-off of PEWS ≥1 was 100% and 59.22%, respectively (PPV, 20.75%; NPV, 100%). Conclusion: The Turkish version of PEWS can be helpful in assessing patient status in pediatric emergency department with acceptable validity and can serve as a potentially screening tool for prediction of ICU admission.

Keywords

• Children
• emergency room
• PEWS
• reliability
• validity

References

1. Chamberlain JM, Patel KM, Pollack MM. The Pediatric Risk of Hospital Admission Score: Asecond-generation severity-of-illness scores for pediatric emergency patients. Pediatrics 2005;115:388–96.
2. Zebrack M, Kadish H, Nelson D. The pediatric hybrid observation unit: an analysis of 6477 consecutive patient encounters. Pediatrics 2005;115(5):e535-42.
3. Simon Junior H, Schvartsman C, Sukys GA, Farhat SCL. Pediatric emergency triage systems. Revista Paulista de Pediatria 2022;41:e2021038.
4. Monaghan A. Detecting and managing deterioration in children. Paediatric Nursing 2005;17(1):32.
5. Chaiyakulsil C, Pandee U. Validation of pediatric early warning score in pediatric emergency department. Pediatrics International : Official Journal of the Japan Pediatric Society 2015;57(4):694-98.
6. de Groot JF, Damen N, de Loos E, et al. Implementing paediatric early warning scores systems in the Netherlands: future implications. BMC Pediatrics 2018;18(1):12.
7. Rosman SL, Karangwa V, Law M, Monuteaux MC, Briscoe CD, McCall N. Provisional Validation of a Pediatric Early Warning Score for Resource-Limited Settings. Pediatrics 2019;143(5):e20183657.
8. Agulnik A, Malone S, Puerto-Torres M, et al. Reliability and validity of a Spanish-language measure assessing clinical capacity to sustain Paediatric Early Warning Systems (PEWS) in resource-limited hospitals. BMJ Open 2021;11(10):e053116.

9. Rosman SL, Daneau Briscoe C, Rutare S, et al. The impact of pediatric early warning score and rapid response algorithm training and implementation on interprofessional collaboration in a resource-limited setting. PLoS One 2022;17(6):e0270253.
10. Bonafide CP, Localio AR, Roberts KE, Nadkarni VM, Weirich CM, Keren R. Impact of rapid response system implementation on critical deterioration events in children. JAMA Pediatrics 2014;168(1):25–33.
11. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 2000;25:3186-91.
12. Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. Journal of Clinical Epidemiology 1993;46:1417-32.
13. Brown SR, Martinez Garcia D, Agulnik A. Scoping Review of Pediatric Early Warning Systems (PEWS) in Resource-Limited and Humanitarian Settings. Frontiers in Pediatrics 2019;6:410.
14. Egdell P, Finlay L, Pedley DK. The PAWS score: Validation of an early warning scoring system for the initial assessment of children in the emergency department. Emergency Medicine Journal 2008;25:745–9.
15. Roland D, Oliver A, Edwards ED, Mason BW, Powell CV. Use of paediatric early warning systems in Great Britain: has there been a change of practice in the last 7 years?. Archives of Disease in Childhood 2014;99(1):26-9.