Medical journal of the Islamic Republic of Iran · 2026
The Role of Pediatric Early Warning Scores (PEWS) in Determining PICU Transfer Necessity and Length of Stay.
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Ashayeri Neda, Aghajani Delavar Motahareh, Hosseini Elahe, Mohammadzadeh Azar, Mohazzab Arash, Velayati Atefeh
Аннотация
BACKGROUND: Early identification of clinical deterioration in hospitalized children remains a major challenge, particularly in determining the need for Pediatric Intensive Care Unit (PICU) transfer. Pediatric Early Warning Scores (PEWS) have been proposed as a tool to support clinical decision-making. This study aimed to evaluate the association between PEWS and PICU transfer, as well as patient outcomes in hospitalized children.
METHODS: This cross-sectional study included all children hospitalized in the wards or referred to the emergency department of Aliasghar Hospital who required a PICU consultation from September 2023 to February 2024. A pediatrician independently completed the PEWS for each child before the PICU consultation. The outcomes measured were transfer to the PICU, length of stay (LOS) in the PICU, duration of ward hospitalization, and mortality. Statistical analyses included Pearson correlation, Chi-square test, and post hoc Least Significant Difference (LSD) test. Multivariate logistic regression models were constructed to assess the independent effect of PEWS on PICU transfer, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Model performance was evaluated using receiver operating characteristic (ROC) curve analysis.
RESULTS: A total of 169 children were included (mean (SD) age: 5.00 (4.65) years; 103 [60.9%] male). The mean (SD) LOS was 4.42 (3.97) days in the ward and 8.54 (6.98) days in the PICU. The mean PEWS was 6.90 (2.22), with 112 (66.3%) patients classified as red and 9 (5.3%) as green. Nine patients (9/169, 5.3%), all in the red category, died during hospitalization. Higher PEWS scores were significantly associated with increased odds of PICU transfer (OR = 3.17, 95% CI: 1.79-5.63, P < 0.001). Transfer rates increased across PEWS categories, reaching 100% in the red group. Significant differences in PICU LOS were observed across PEWS severity groups, with patients in the red category having longer stays.
CONCLUSION: PEWS is a valuable tool for early detection of deterioration, but should not be used alone for PICU transfer decisions. Clinical context, underlying diagnoses, and ongoing assessment must be considered alongside PEWS scores for effective patient management.
METHODS: This cross-sectional study included all children hospitalized in the wards or referred to the emergency department of Aliasghar Hospital who required a PICU consultation from September 2023 to February 2024. A pediatrician independently completed the PEWS for each child before the PICU consultation. The outcomes measured were transfer to the PICU, length of stay (LOS) in the PICU, duration of ward hospitalization, and mortality. Statistical analyses included Pearson correlation, Chi-square test, and post hoc Least Significant Difference (LSD) test. Multivariate logistic regression models were constructed to assess the independent effect of PEWS on PICU transfer, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Model performance was evaluated using receiver operating characteristic (ROC) curve analysis.
RESULTS: A total of 169 children were included (mean (SD) age: 5.00 (4.65) years; 103 [60.9%] male). The mean (SD) LOS was 4.42 (3.97) days in the ward and 8.54 (6.98) days in the PICU. The mean PEWS was 6.90 (2.22), with 112 (66.3%) patients classified as red and 9 (5.3%) as green. Nine patients (9/169, 5.3%), all in the red category, died during hospitalization. Higher PEWS scores were significantly associated with increased odds of PICU transfer (OR = 3.17, 95% CI: 1.79-5.63, P < 0.001). Transfer rates increased across PEWS categories, reaching 100% in the red group. Significant differences in PICU LOS were observed across PEWS severity groups, with patients in the red category having longer stays.
CONCLUSION: PEWS is a valuable tool for early detection of deterioration, but should not be used alone for PICU transfer decisions. Clinical context, underlying diagnoses, and ongoing assessment must be considered alongside PEWS scores for effective patient management.