PREDICTING OUTCOME USING PEDIATRIC EARLY WARNING SYSTEM (PEWS) SCORE ON PICU ADMISSION: A STUDY FROM A LOWER-MIDDLE-INCOME COUNTRY

Abstract

Background: The Paediatric Early Warning System (PEWS) Score is a well-established tool for identifying clinical deterioration in hospitalised children and facilitating early intervention. While PEWS is primarily used in ward settings, its utility in predicting clinical outcomes at the time of admission to the Paediatric Intensive Care Unit (PICU), such as mortality, length of stay, and need for mechanical ventilation, has not been extensively studied, particularly in resource-limited settings. Understanding the prognostic value of PEWS in PICU could help optimise patient management and resource allocation in such environments. Objective: To assess the validity of the Paediatric Early Warning System (PEWS) score as a predictor of mortality in the Paediatric Intensive Care Unit (PICU) at The Children's Hospital Lahore, Pakistan. Study Design: Prospective cohort study. Settings: The Children's Hospital Lahore, Pakistan. Duration of Study: April to July 2024. Methods: A total of 180 children admitted to the PICU were included in the study. The PEWS score was recorded at the time of admission. The primary outcome was mortality, while secondary outcomes included length of stay and the requirement for mechanical ventilation. Logistic regression analysis was performed to assess the association between PEWS scores and clinical outcomes. Results: Out of the 180 children enrolled, the overall mortality rate was 16.6%. A significant association was found between a PEWS score ≥7 at admission and increased mortality, with 75% of the deceased patients (22 out of 30) having a PEWS score ≥7 (OR = 6.2, 95% CI: 2.8–14.1, p < 0.001). This indicates that children with a higher PEWS score were more than six times as likely to die compared to those with lower scores. Additionally, higher PEWS scores were linked to longer PICU stays. Children with PEWS scores ≥7 had an average PICU stay of 10.5 days, significantly longer than those with scores <7, who stayed an average of 4.3 days (OR = 3.4, 95% CI: 1.2–9.8, p = 0.02). Furthermore, the need for mechanical ventilation was significantly higher in patients with higher PEWS scores, with 55% of patients requiring ventilator support compared to only 12% in those with PEWS scores <7 (OR = 5.1, 95% CI: 1.8–14.5, p = 0.01). Conclusion: The PEWS score is a simple and effective tool for predicting mortality risk in the PICU, particularly in low-resource settings, helping optimise resource allocation and patient management. However, it is important to continue monitoring patients with lower PEWS scores, as the system may not identify all patients at risk of deterioration. Further research could explore the integration of PEWS with other clinical markers for improved predictive accuracy.