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Evaluation of a modified paediatric early warning score for children with congenital heart disease

Published online by Cambridge University Press:  11 September 2023

Simone Commotio Open the ORCID record for Simone Commotio [Opens in a new window] ,
Nicolas Leister Open the ORCID record for Nicolas Leister [Opens in a new window] ,
Christoph Menzel ,
Christoph Ulrichs ,
Wolfgang A. Wetsch ,
Mathias Emmel  and
Uwe Trieschmann Open the ORCID record for Uwe Trieschmann [Opens in a new window]
Simone Commotio*
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Germany
Nicolas Leister
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Germany
Christoph Menzel
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Germany
Christoph Ulrichs
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Germany
Wolfgang A. Wetsch
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Germany
Mathias Emmel
Affiliation:
Department of Paediatric Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
Uwe Trieschmann
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, Cologne, Germany
*
Corresponding author: S. Commotio; Email: simone.commotio@uk-koeln.de
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Abstract

Background:

Paediatric early warning score systems are used for early detection of clinical deterioration of patients in paediatric wards. Several paediatric early warning scores have been developed, but most of them are not suitable for children with cyanotic CHD who are adapted to lower arterial oxygen saturation.

Aim:

The present study compared the original paediatric early warning system of the Royal College of Physicians of Ireland with a modification for children with cyanotic CHD.

Design:

Retrospective single-centre study in a paediatric cardiology intermediate care unit at a German university hospital.

Results:

The distribution of recorded values showed a significant shift towards higher score values in patients with cyanotic CHD (p < 0.001) using the original score, but not with the modification. An analysis of sensitivity and specificity for the factor “requirement of action” showed an area under the receiver operating characteristic for non-cyanotic patients of 0.908 (95% CI 0.862–0.954). For patients with cyanotic CHD, using the original score, the area under the receiver operating characteristic was reduced to 0.731 (95% CI 0.637–0.824, p = 0.001) compared to 0.862 (95% CI 0.809–0.915, p = 0.207), when the modified score was used. Using the critical threshold of scores ≥ 4 in patients with cyanotic CHD, sensitivity and specificity for the modified score was higher than for the original (sensitivity 78.8 versus 72.7%, specificity 78.2 versus 58.4%).

Conclusion:

The modified score is a uniform scoring system for identifying clinical deterioration, which can be used in children with and without cyanotic CHD.

Keywords

Patient safetyearly warning scorepaediatricheart defectscongenitalcardiopulmonary arrestICUpaediatric
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 3 , March 2024 , pp. 637 - 642
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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