UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

"The Score Matters": Wide Variations in Predictive Performance of 18 Paediatric Track and Trigger Systems

Chapman, SM; Wray, J; Oulton, K; Pagel, C; Ray, S; Peters, M; (2017) "The Score Matters": Wide Variations in Predictive Performance of 18 Paediatric Track and Trigger Systems. Archives of Disease in Childhood , 102 (6) pp. 487-495. 10.1136/archdischild-2016-311088. Green open access

[thumbnail of Chapman_Predictive_validity_of_PEWS_manscript_ADC Unmarked Revision 2 2016.12.13.pdf]
Preview
Text
Chapman_Predictive_validity_of_PEWS_manscript_ADC Unmarked Revision 2 2016.12.13.pdf - Accepted Version

Download (638kB) | Preview

Abstract

Objective: To compare the predictive performance of 18 Paediatric Early Warning Systems (PEWS) in predicting critical deterioration. / Design: Retrospective case-controlled study. PEWS values were calculated from existing clinical data and the area under the receiver operator characteristic curve (AUROC) compared. / Setting: UK tertiary referral children’s hospital. / Patients: Patients without a ‘do not attempt resuscitation’ order admitted between 1st January 2011 and 31st December 2012. All patients on paediatric wards who suffered a critical deterioration event were designated ‘cases’ and matched with a control closest in age who was present on the same ward at the same time. / Main outcome measures: Respiratory and/or cardiac arrest, unplanned transfer to paediatric intensive care and/or unexpected death. / Results: Twelve ‘scoring’ and 6 ‘trigger’ systems were suitable for comparative analysis. 297 case events in 224 patients were available for analysis. 244 control patients were identified for the 311 events. Three PEWS demonstrated better overall predictive performance with an AUROC of 0.87 or greater. Comparing each system to the highest performing PEWS with Bonferroni’s correction for multiple comparisons resulted in statistically significant differences for 13 systems. Trigger systems performed worse than scoring systems, occupying the 6 lowest places in the AUROC rankings. / Conclusion: There is considerable variation in the performance of published PEWS and as such the choice of PEWS has the potential to be clinically important. Trigger based systems performed poorly overall but it remains unclear what factors determine optimum performance. More complex systems did not necessarily demonstrate improved performance.

Type: Article
Title: "The Score Matters": Wide Variations in Predictive Performance of 18 Paediatric Track and Trigger Systems
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/archdischild-2016-311088
Publisher version: http://dx.doi.org/10.1136/archdischild-2016-311088
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences > Dept of Mathematics
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences > Dept of Mathematics > Clinical Operational Research Unit
URI: https://discovery.ucl.ac.uk/id/eprint/1536132
Downloads since deposit
258Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item