The PEWS; Can It Be Used to Safely Triage the Traumatically Injured Pediatric Patient? A Quality Improvement Initiative
William Gazzola MD, MD1; Amanda Felder, RN2; Stephanie Hirth, Medical Student3; Katie Braxton, MD1; Martin Durkin, MD, MPH1; Juan I. Camps, MD, MBA1
1Palmetto Health Children's Hospital, Columbia, SC; 2Palmetto Health Children's Hospital, Columbia, OR; 3University of Cincinnati Medical School, Columbia, SC
Background: Quantifying the severity of a traumatic injury during the initial evaluation is essential for a proper triage, adequate treatment and proper patient bed allocation. This is a Quality and Process Improvement initiative to assess the optimal timing to evaluate pediatric trauma patients by a pediatric surgeon.
Methods: At our institution, The Pediatric Early Warning Score (PEWS) was implemented to triage every pediatric trauma patient. This score was used to triage the patients according with the algorithm in fig. 1. At discharge, each patient had calculated the Injury Severity Score and compared to the PEWS values.
Results: Over a year, 314 pediatric trauma patients came thru the emergency department. The mean age was 6.7 years (range zero to 15). Independently of the severity of the trauma alert, 263 (83.8%) patients had PEWS ≤ 2. The risk of under triage on an ISS ≥15 was 4.9%. However for a PEWS of 3 or 4, the risk of under triage was 40.9% [RR 7.71, (3.72, 16.01), p<0.001]. The risk of under triage on an ISS ≥ 25 was 0.4%. However for a PEWS ≥ 3-4, the risk of under triage was 13.6% [RR 18.00 (1.95, 165.89), p=0.002].
Conclusion: These results suggest that our current system accurately triages the non-urgent pediatric patient to a non-monitored bed after evaluation by emergency medicine or general surgical team. The pediatric surgeon should promptly evaluate children with PEWS ≥ 3 in order to determine the need for higher level of care.
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