Effect of a pediatric early warning system on all-cause mortality in Hospitalized pediatric patients: The epoch randomized clinical trial

Christopher S. Parshuram, Karen Dryden-Palmer, Catherine Farrell, Ronald Gottesman, Martin Gray, James S. Hutchison, Mark Helfaer, Elizabeth A. Hunt, Ari R. Joffe, Jacques Lacroix, Michael Alice Moga, Vinay Nadkarni, Nelly Ninis, Patricia C. Parkin, David Wensley, Andrew R. Willan, George A. Tomlinson, Ariane Willems, Malika Hazim, Bernard WenderickxAfrothite Kotsakis, Sarah Gander, Wendy Harris, Joanna Holland, Julie MacLean, Darlene Boliver, Samara Zavalkoff, Maryse Dagenais, Sarah Shea, Josee Gaudreault, Marc Andre Dugas, Louise Gosselin, Caroline Proulx-Clerc, Laurence Bertout, Isabelle Grisoni, Jonathan Duff, Jodie Pugh, Denise Capito, Gordon Krahn, Amanda Barclay, Fiona Auld, Laurie Robson, Emma Carrick, Jonathan Gilleland, Lois Saunders, Douglas Fraser, Paige Bechard, Colleen Martin, Lindsay Spear, Kathleen Tobler, Kimberly Kulbaba, Nicola Peiris, Dermot R. Doherty, Fcarcsi Fjficmi, Emma Ladewig, Suja Somanadhan, Louise Greensmith, Cormac Breatnach, Cathal O'Rourke, Bambino Gesù, Corrado Cecchetti, Orsola Gawronski, Aranna Ruscitto, Ester Pagaduan Cabillon, Marta Ciofi Degli Atti, Massimiliano Raponi, Gabrielle Nuthall, Gregory D. Williams, Claire Sherring, Tracey Bushell, Miriam Rea, Louise Armriding, Greta Olykan, Cynthia Van Der Starre, Angelique Hogeboom, Andrea De Oude-Lubbers, Nargis Hemat, Simon Broughton, Sarah Harris, Emily Downing, David Inwald, Ruchi Sinha, Sophie Raghunanan, Mamta Vaidya, Leanne Reardon, Margarita Burmester, Kanwarjit Kailay, Loredana Haidu, Susan Ferri, Jessica Grillo, Nida Shahid, Sarah Ashley, Simran Singh, Kate Byrne, Aarthi Kamath, Kristen Middaugh

Research output: Contribution to journalArticlepeer-review

170 Citations (Scopus)

Abstract

IMPORTANCE: There is limited evidence that the use of severity of illness scores in pediatric patients can facilitate timely admission to the intensive care unit or improve patient outcomes. OBJECTIVE: To determine the effect of the Bedside Paediatric Early Warning System (BedsidePEWS) on all-cause hospital mortality and late admission to the intensive care unit (ICU), cardiac arrest, and ICU resource use. DESIGN, SETTING, AND PARTICIPANTS: A multicenter cluster randomized trial of 21 hospitals located in 7 countries (Belgium, Canada, England, Ireland, Italy, New Zealand, and the Netherlands) that provided inpatient pediatric care for infants (gestational age ≥37 weeks) to teenagers (aged ≤18 years). Participating hospitals had continuous physician staffing and subspecialized pediatric services. Patient enrollment began on February 28, 2011, and ended on June 21, 2015. Follow-up ended on July 19, 2015. INTERVENTIONS: The BedsidePEWS intervention (10 hospitals) was compared with usual care (no severity of illness score; 11 hospitals). MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause hospital mortality. The secondary outcome was a significant clinical deterioration event, which was defined as a composite outcome reflecting late ICU admission. Regression analyses accounted for hospital-level clustering and baseline rates. RESULTS: Among 144539 patient discharges at 21 randomized hospitals, there were 559 443 patient-days and 144539 patients (100%) completed the trial. All-cause hospital mortality was 1.93 per 1000 patient discharges at hospitals with BedsidePEWS and 1.56 per 1000 patient discharges at hospitals with usual care (adjusted between-group rate difference, 0.01 [95% CI, -0.80 to 0.81 per 1000 patient discharges]; adjusted odds ratio, 1.01 [95% CI, 0.61 to 1.69]; P =.96). Significant clinical deterioration events occurred during 0.50 per 1000 patient-days at hospitals with BedsidePEWS vs 0.84 per 1000 patient-days at hospitals with usual care (adjusted between-group rate difference, -0.34 [95% CI, -0.73 to 0.05 per 1000 patient-days]; adjusted rate ratio, 0.77 [95% CI, 0.61 to 0.97]; P =.03). CONCLUSIONS AND RELEVANCE: Implementation of the Bedside Paediatric Early Warning System compared with usual care did not significantly decrease all-cause mortality among hospitalized pediatric patients. These findings do not support the use of this system to reduce mortality.

Original languageEnglish
Pages (from-to)1002-1012
Number of pages11
JournalJAMA - Journal of the American Medical Association
Volume319
Issue number10
DOIs
Publication statusPublished - Mar 13 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2018 American Medical Association. All rights reserved.

ASJC Scopus Subject Areas

  • General Medicine

PubMed: MeSH publication types

  • Comparative Study
  • Journal Article
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

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