Performances of the Pediatric Early Warning Score (PEWS) to predict early deaths within 24 hours and causes of death in pediatric intensive care unit
Abstract
Background: Different mortality rate in pediatric intensive care unit (PICU) has been reported in varied level of PICU services. No previous study has been done in Nakornping Hospital to explore mortality rate, mortality risk factors, PEWS score and early death risks.
Objectives: To study performances of PEWS score to detect early death in 24 hours, clinical risk factors in early death and describe a mortality rate and causes of death in PICU
Method: A retrospective cohort study was conducted during 1st January 2015 – 31st December 2017. Inclusion criteria were all PICU admissions and deaths aged less than 15 years old. Clinical data was gathered and PEWS score was generated from the first 24 hours of admission data. A mortality rate, causes of death, complications, ability of PEWS score prediction and factors associated with early death. Multivariable exponential risk regression was used for an analysis.
Results: Of 78 deaths during the study time, mortality rate was 6.57%. Patients died in 24 hours was 38.16%. The first five causes of death were pneumonia, sepsis, meningitis, drowning, and myocarditis. We analyzed PEWS in early death within and after 24 hours had mean PEWS 6.92 ± 1.91 and 5.17± 2.05 respectively, coefficient was 0.44 (95% CI 0.16-0.71) p = 0.002. PEWS ³ 5 and early death had RR 3.66 (95%CI 1.21-11.04) p=0.021. Factors related with early death were inotropic drugs used and high serum creatinine at the first 24 hours of admission.
Conclusion: PEWS score with a cut-off point at ³ 5 increased risk of death in 24 hours. Factors associated early death were inotropic drugs used and high serum creatinine.
Keywords: PICU, PEWS, early death in 24 hours, mortality, mortality risk factors
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