Utilidad de una escala de alerta temprana como predictor precoz de deterioro clínico en niños internados / Usefulness of an early warning score as an early predictor of clinical deterioration in hospitalized children

Introducción. La detección temprana del deterioro clínico en pacientes internados posibilita mejorar la calidad de atención médica. Las escalas Pediatric Early Warning Score (PEWS) predicen este deterioro dentro de las primeras 24 h de aplicadas. Estudios previos avalan estas herramientas.Objetivo. Evaluar la utilidad de la escala B-PEWS(Brighton PEWS) para predecir el deterioro clínico en niños internados, en un hospital pediátrico de la Ciudad de Buenos Aires.Población y métodos. Diseño de corte transversal. Incluyó todas las historias clínicas de pacientes de 1 mes a 18 años hospitalizados en áreas de hospitalización indiferenciada, desde el 1 de marzo al 31 de agosto de 2018. Variable de predicción: valor de B-PEWS (≤ 3 y ≥ 4 puntos). Variable de resultado: deterioro clínico dentro de las 24 horas. Análisis de variables categóricas mediante prueba de chi2 y cálculo de valores de clivaje. Como medida de asociación, se usó riesgo relativo. Se realizó análisis de curva ROCy análisis de punto óptimo mediante índice de Youden, tomando la escala de manera continua.Resultados. Se analizaron 518 historias clínicas. Cuarenta pacientes presentaron deterioro clínico; 37 con B-PEWS ≥ 4, y 3 con B-PEWS ≤ 3 (RR 56,36; IC 95 %: 17,76-178,89; p < 0,01). Sensibilidad: el 92,5 %; especificidad: el 88,3 %; valor predictivo positivo: el 39,8 %; negativo: el 99,3 %; razón de verosimilitud positiva: 7,91; razón de verosimilitud negativa: 0,08. AUC: 0,94 (IC 95 %: 0,89-0,98).Conclusión. La escala B-PEWS demostró ser útil para predecir el deterioro clínico en niños hospitalizados

Introduction. The early detection of clinical deterioration in hospitalized patients helps to improve the quality of care. The pediatric early warning score (PEWS) system predicts such deterioration in the first 24 hours of administration. Prior studies support the use of these tools.Objective. To assess the usefulness of the Brighton PEWS (B-PEWS) for the prediction of clinical deterioration among hospitalized children at a children's hospital in the Autonomous City of Buenos Aires.Population and methods. Cross-sectional study. The medical records of all patients aged 1 month to 18 years admitted to any hospitalization ward between March 1st and August 31st, 2018 were included. Predictive outcome measure: B-PEWS score (≤ 3 and ≥ 4 points). Outcome variable: clinical deterioration in the first 24 hours. Categorical outcome measures were analyzed with the χ² test and screening values were estimated. The relative risk was used as a measure of association. A ROC curve analysis and an optimal cut-point analysis according to the Youden index were done considering the score in a continuous manner.Results. A total of 518 medical records were reviewed. Forty patients had clinical deterioration; the B-PEWS score was ≥ 4 in 37 patients and ≤ 3 in 3 (relative risk: 56.36; 95 % confidence interval: 17.76-178.89; p < 0.01). Sensitivity: 92.5 %; specificity: 88.3 %; positive predictive value: 39.8 %; negative predictive value: 99.3 %; positive likelihood ratio: 7.91; negative likelihood ratio: 0.08. AUC:0.94 (95 % confidence interval: 0.89-0.98).Conclusion. The B-PEWS demonstrated to be useful to predict clinical deterioration in hospitalized children.

Usefulness of an early warning score as an early predictor of clinical deterioration in hospitalized children. / Utilidad de una escala de alerta temprana como predictor precoz de deterioro clínico en niños internados.

INTRODUCTION: The early detection of clinical deterioration in hospitalized patients helps to improve the quality of care. The pediatric early warning score (PEWS) system predicts such deterioration in the first 24 hours of administration. Prior studies support the use of these tools. OBJECTIVE: To assess the usefulness of the Brighton PEWS (B-PEWS) for the prediction of clinical deterioration among hospitalized children at a children's hospital in the Autonomous City of Buenos Aires. POPULATION AND METHODS: Cross-sectional study. The medical records of all patients aged 1 month to 18 years admitted to any hospitalization ward between March 1st and August 31st, 2018 were included. Predictive outcome measure: B-PEWS score (≤ 3 and ≥ 4 points). Outcome variable: clinical deterioration in the first 24 hours. Categorical outcome measures were analyzed with the χ² test and screening values were estimated. The relative risk was used as a measure of association. A ROC curve analysis and an optimal cut-point analysis according to the Youden index were done considering the score in a continuous manner. RESULTS: A total of 518 medical records were reviewed. Forty patients had clinical deterioration; the B-PEWS score was ≥ 4 in 37 patients and ≤ 3 in 3 (relative risk: 56.36; 95 % confidence interval: 17.76-178.89; p < 0.01). Sensitivity: 92.5 %; specificity: 88.3 %; positive predictive value: 39.8 %; negative predictive value: 99.3 %; positive likelihood ratio: 7.91; negative likelihood ratio: 0.08. AUC: 0.94 (95 % confidence interval: 0.89-0.98). CONCLUSIONS: The B-PEWS demonstrated to be useful to predict clinical deterioration in hospitalized children.

Introducción. La detección temprana del deterioro clínico en pacientes internados posibilita mejorar la calidad de atención médica. Las escalas Pediatric Early Warning Score (PEWS) predicen este deterioro dentro de las primeras 24 h de aplicadas. Estudios previos avalan estas herramientas. Objetivo. Evaluar la utilidad de la escala B-PEWS (Brighton PEWS) para predecir el deterioro clínico en niños internados, en un hospital pediátrico de la Ciudad de Buenos Aires. Población y métodos. Diseño de corte transversal. Incluyó todas las historias clínicas de pacientes de 1 mes a 18 años hospitalizados en áreas de hospitalización indiferenciada, desde el 1 de marzo al 31 de agosto de 2018. Variable de predicción: valor de B-PEWS (≤ 3 y ≥ 4 puntos). Variable de resultado: deterioro clínico dentro de las 24 horas. Análisis de variables categóricas mediante prueba de chi2 y cálculo de valores de clivaje. Como medida de asociación, se usó riesgo relativo. Se realizó análisis de curva ROC y análisis de punto óptimo mediante índice de Youden, tomando la escala de manera continua. Resultados. Se analizaron 518 historias clínicas. Cuarenta pacientes presentaron deterioro clínico; 37 con B-PEWS ≥ 4, y 3 con B-PEWS ≤ 3 (RR 56,36; IC 95 %: 17,76-178,89; p < 0,01). Sensibilidad: el 92,5 %; especificidad: el 88,3 %; valor predictivo positivo: el 39,8 %; negativo: el 99,3 %; razón de verosimilitud positiva: 7,91; razón de verosimilitud negativa: 0,08. AUC: 0,94 (IC 95 %: 0,89-0,98). Conclusión. La escala B-PEWS demostró ser útil para predecir el deterioro clínico en niños hospitalizados.

Role of Late DMSA Renal Scan in Detecting High-Grade Vesicoureteral Reflux.

OBJECTIVE: To determine the performance of late dimercaptosuccinic acid (DMSA) renal scans in identifying high-grade (III-V) vesicoureteral reflux (VUR) in children aged over 3 y with a febrile urinary tract infection (fUTI) history that has not been timely investigated. METHODS: In this retrospective study of diagnostic accuracy, the clinical records of children aged between 3 and 18 y with fUTI history evaluated consecutively at Nephrology Unit of Hospital General de Niños Pedro de Elizalde, Argentina between 2006 and 2016 were reviewed. Patients with previously diagnosed renal or urinary tract abnormalities or who underwent previous postnatal genitourinary imaging were excluded. Only those assessed by renal and bladder ultrasound (RBUS), voiding cystourethrogram (VCUG) and late 6-mo DMSA scan were analyzed. The ability of the scintigraphy in identifying high-grade VUR was determined by comparing its findings with those of VCUG. RESULTS: In 122 children (median age 5.37 y, 88.5% girls) RBUS was abnormal in 53 (43.4%) and 58 (47.5%) had VUR (30 of high-grade). Abnormal DMSA scan findings (70 patients, 57.4%) were associated with all grade (p = 0.00001) and with high-grade VUR (p = 0.00001). Sensitivity, specificity, negative (NPV) and positive (PPV) predictive values of late DMSA scans for all grades VUR were 93.1%, 75%, 92.3% and 77.1%, respectively. Only 4 patients with low-grade VUR had normal scans. For high-grade VUR, sensitivity and NPV reached 100%. CONCLUSIONS: In older children, the normal late DMSA scan predicted the absence of high-grade VUR, obviating the need for a VCUG. This approach could be a possible strategy for children not studied at acute infection time.