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Table 4 Patient characteristics, by timing of PICU or ward admission

From: Escalation of care in children at high risk of clinical deterioration in a tertiary care children’s hospital using the Bedside Pediatric Early Warning System

PICU admission

YES

NO

 

Time from enrollment, hours

 ≤ 6*

7–12a

13–18a

19–24a

 < 6–24a

At 24

P value **

Patients, n (%)

37 (37)

13 (13)

17 (17)

32 (32)

99

129

 

Age, median (IQR), years

1 (0–5)

1 (0–5)

1 (0–4)

1 (0–7)

1(0–5)

1 (0–4)

0.59

Maximum BedsidePEWS, median (IQR)

10 (8–12)

9 (7–11)

9 (7–10)

7 (7–8)

10(8–13)

9 (8–11)

0.02

Chronic Disease, n (%)

23 (62)

8 (62)

9 (53)

22 (69)

62(63)

127 (98)

 < 0.0001

Diagnosis, n (%)

      

 < 0.0001

 Haematology-Oncology,

7 (19)

2 (15)

5 (29)

10 (31)

24(24)

13(10)

 

 Cardiac

-

1 (7)

2 (12)

9 (28)

12(9)

12 (12)

 

 Respiratory

18 (49)

7 (54)

9 (53)

11 (34)

45(45)

50 (39)

 

 Neurological or Endocrine

12 (3)

3 (23)

1(6)

2 (6)

18(18)

12 (9)

 

CRIS

      

 < 0.0001

  (1–4) (Early) n (%)

35 (95)

11 (85)

14 (82)

26 (81)

86 (87)

129

 

 >  = 5 (Late) n (%)

2 (5)

2 (15)

3 (18)

6 (19)

13 (13)

0

 

Median (IQR)

1 (1–2)

1 (1–2)

1 (1–2)

1(1–3.5)

1 (1–3)

1(1–1)

 < 0.0001

Recent transfer, n (%)

21 (57)

5 (38)

7 (41)

4 (13)

37(54)

31(46)

0.03

 ER < 24 h

13 (35)

2 (15)

4 (24)

1 (3)

   

 PICU readmissions < 48 h

4 (11)

-

1 (6)

1 (3)

   

 Other

4 (11)

2 (15)

2 (12)

2 (6)

   

PICU consult n (%)

30 (81)

13 (100)

13 (76)

27 (84)

83(84)

 

 < 0.0001

Intubation n (%)

1 (3)

0

0

5 (16)

6 (6)

0

0.005

First EI score, median (IQR)

6(4–7)

5(4–6)

4(3–5)

4(2–4)

5(4–6)

2(4–4)

 < 0.001

Ward Physician review < 2–4 h, n (%)

29 (78)

11(84)

12(71)

19(59)

71(72)

71(55)

0.01

PICU consult < 6 h from first BedsidePEWS ≥ 7, n (%)

30 (81)

8(61)

8(47)

10(31)

56(57)

13(10)

 < 0.0001

BedsidePEWS documentation hourly, n (%)

19(62)

5(38)

3(19)

3(9)

30(32)

17(13)

0.001

ECG + SpO2, n (%)

27(73)

12(92)

16(100)

32(100)

87(88)

108()

0.28

Escalation index (median, IQR)

4 (2–4)

3(2–4)

4(3–5)

4(2–6)

6(5–7)

4(3–5)

 < 0.0001

Q: Would you have called for an urgent PICU consult for this patient

 Phisicians,  median (IQR)

10(10–10)

10(10–10)

10(9–10)

10(8–10)

10(9–10)

5(2–8)

 < 0.0001

 Nurses, median (IQR)

9(9–10)

10(10–10)

10(10–10)

9(6–10)

10(9–10)

8.5(4–10)

0.002

Q: How much would you have been surprised if this patient arrested during your shift

 Phisicians, median (IQR)

6 (3.5–7)

3(2–5)

5(3–9)

6(3–9)

5(2–7)

7(3–9)

0.01

 Nurses, median (IQR)

4(2–6.5)

4(2–7)

4(2–7)

4(2–7)

4(2–7)

3.5(2–6)

0.59

  1. Legend: EI Escalation Index, CRIS Childrens’ Resuscitation Intensity Scale, ER Emergency Room, PICU Pediatric Intensive Care Unit, ECG Electrocardiogram, SpO2 Peripheral Oxygen Saturation.
  2. PICU admission more than 24 h after enrolment occurred in 21 (29%) patients at a median (IQR) of 18 days (7–34) following ward admission. There were no PICU admissions within 48 h of enrolment, suggesting that the use of 24-h disposition ensure an appropriate separation of the patients into the ward and ICU groups. Patients admitted to the ICU after 24 h of enrolment had a cardiac diagnosis (n = 18, 86%), one resuscitation team call was made, and all were admitted with CRIS scores equal to 4 or less
  3. aduration of the time interval
  4. **P value = PICU admission (YES) vs no PICU admission (NO)