dallas 2015 tfqo: ian maconochie coi # 99 evrevs: alexis topjian coi # 303 taskforce: antonio...
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Dallas 2015
TFQO: Ian Maconochie COI # 99EVREVs: Alexis Topjian COI # 303Taskforce: Antonio Rodriguez-Nunez COI # 14
Peds-818: Pediatric Early Warning
Scores
Dallas 2015
COI Disclosure
Alexis Topjian COI # 303Antonio Rodriguez-Nunez COI # 14
Commercial/industry•None
Potential intellectual conflicts•None
Dallas 20152010 CoSTR
Topic not reviewed in 2010
Dallas 2015C2015 PICO
Population: Infants and children in the in-hospital settingIntervention: Use of a Pediatric Early Warning ScoreComparison: Not using a Pediatric Early Warning ScoreOutcomes: Overall hospital mortality (7-critical)
Cardiac arrest frequency outside the ICU (6-important)
Dallas 2015Inclusion/Exclusion& Articles Found
Inclusions/ExclusionsInclusion: Observational retrospective or prospective, RCT, Pediatrics, Early Warning Score (of any type)Exclusion: not related to the PICO question, evaluations of Rapid Response Teams, Abstracts
Number of articles initially identified: 1741RCT: 0 Non-RCT: 1Excluded: 1740
Dallas 20152015 Proposed Treatment Recommendations
We suggest using a Pediatric Early Warning Score/ System for early detection of children at risk of respiratory or cardiac arrest in the in-hospital setting
(weak recommendation, very low quality of evidence).
Dallas 2015 Risk of Bias in studies
Dallas 2015Evidence profile table(s)
Author(s): Alexis Topjian and Antonio Rodriguez-NunezDate: 2 November 2014Question: Should PEWS vs. No PEWS be used in in-hospital pediatric patients?Settings: Hospital mortality, Cardiac arrest outside ICUBibliography (systematic reviews): None.
Quality assessment№ of patients Effect
QualityImportanc
e№ of studies
Study design
Risk of bias
Inconsistency IndirectnessImpreci
sionOther considerations PEWS
No PEWS
Relative(95% CI)
Absolute
(95% CI)
CARDIAC ARREST
1Randhawa, 2011
observational studies
serious 3 Not serious serious 3 serious 1 publication bias strongly suspectedall plausible residual confounding would reduce the demonstrated effect 1
NoneSpecified
NoneSpecified
not estimabl
e
not estima
ble
⨁◯◯◯
VERY LOW
CRITICAL
MORTALITY AFTER CARDIAC ARREST
1 Randhawa, 2011
observational study
very serious 2
Not serious serious 2 serious 2 publication bias strongly suspectedall plausible residual confounding would reduce the demonstrated effect 1
NoneSpecified
NoneSpecified
not estimabl
e
not estima
ble
⨁◯◯◯VERY LOW
CRITICAL
Dallas 2015Proposed Consensus on Science statements
For the critical outcome of incidence of cardiac arrest, we have identified evidence from one very low quality pediatric observational study (downgraded for risk of bias, indirectness, imprecision and possible publication bias) describing improved outcome with the use of PEWS in a hospital (Randhawa, 2011, 443)
For the critical outcome of reduced mortality from cardiac arrest, we have identified no evidence that showed changes in cardiac arrest rate or mortality outside of the PICU setting.
Dallas 2015Draft Treatment Recommendations
We suggest using a Pediatric Early Warning Score/ System for early detection of children at risk of respiratory or cardiac arrest in the in-hospital setting (weak recommendation, very low quality of evidence).
Dallas 2015Knowledge Gaps
If PEWS independent of intervention have an impact on outcomesSpecific research required
Prospective research evaluating PEWSEvaluating efficacy of different PEWS
Dallas 2015Next Steps
This slide will be completed during Task Force Discussion (not EvRev) and should include:
Consideration of interim statementPerson responsibleDue date
Essential slide (one slide only). Estimated time <30 sec
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