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