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Table 5 Patient characteristics and staff perceptions of clinical deterioration, by ICU admission and escalation of carea

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 “24 h

 

NO

YES

P value*

Maximum Escalation Index score

 < 5

≥5

 < 5

≥5

 

Patient characteristics

 Maximum BedsidePEWS in last full 6- hour period, median (IQR)

7 (6–9)

7 (6–8)

9 (7–14)

10 (8–12)

0.37

 Maximum BedsidePEWS

median (IQR)

9 (7–11)

11 (9–11)

10 (8–14)

10 (8–12)

0.02

 Maximum BedsidePEWS ≥10, n (%)

46/113 (41)

11/16 (69)

21/40 (53)

34/59 (58)

0.142

  CRIS, n (%)

  1–4

113 (100)

16 (100)

33 (83)

53 (90)

 < 0.0001

  5–7

0 (0)

0 (0)

7 (17)

6 (10)

 Recent transfer, n (%)

  Yes

25

6

12

25

0.03

 PICU Team Called, n (%)

  <  = 6 h

4 (4)

9 (56)

17 (42)

39 (66)

 < 0.0001

  6–12 h

1 (1)

3 (19)

2 (5)

7 (11)

  > 12 h

0

3 (19)

5 (12)

13 (22)

  no call

108 (96)

1 (6)

16 (40)

0

 Medication complexity, n (%)

  Yes

72 (64)

6 (37)

21 (53)

31 (53)

0.230

  No

41 (36)

10 (63)

19 (47)

28 (47)

 Isolation, n (%)

  Yes

34 (31)

5 (33)

12 (30)

27 (46)

0.21

  No

76 (69)

10 (67)

28 (70)

32 (54)

 Chronic disease, n (%)

  Yes

  No

112 (99)

1 (1)

15 (94)

1 (6)

26 (65)

14 (35)

36 (61)

23 (39)

 < 0.0001

 HCP perception of patient deterioration, mean, SD

  Q: How much would ou have been surprised if this patient arrested? Physicians

4.85 ±

3.43

7.86 ± 2.19

8.53 ± 3.11

9.61 ± 0.79

0.02

  Q: Would you have called for a PICU consult fo this patient? Physicians

4.54 ± 3.40

5.17 ± 2.64

8.60 ± 3.11

9.46 ± 0.88

 < 0.0001

  Q: How much would you have been surprised if this patient arrested? Nurses

6.88 ± 3.38

8.67 ± 1.86

8.22 ± 2.97

9.06 ± 1.98

0.75

  Q: Would you have called for a PICU consult for this patient? Nurses

6.40 ± 3.20

6.83 ± 2.56

8.57 ± 2.69

9.09 ± 1.99

0.002

  1. Patients who were not admitted to the PICU, with higher BedsidePEWS scores and Escalation Indexes had the greatest improvement (lower BedsidePEWS scores) at the end of the observation period. PICU = Pediatric Intensive Care Unit;  CRIS = Children’s Resuscitation Intensity Score; HCP = Health Care Professionals; Q = Question
  2. aThis table compares escalation practices (the highest escalation index) in patients admitted to PICU and patients who remained on the wards during the 24-h observation period. There was a median (IQR) of 2 (1-3) 6-h periods with one or more BedsidePEWS scores ≥ 7 in patients admitted to the PICU and 3 (3-4) in patients remaining on the ward. These permitted the calculation of 574 Escalation Index values. The escalation index ranges from 1–7. Escalation of care was classified as “low escalation” for an escalation index score = 1–4, and “high escalation” for an escalation index score = 5–7
  3. *P = PICU admission vs no PICU admission
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BMC Pediatrics

ISSN: 1471-2431

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