73 in cases and the difference between the mean score of cases and control patients by 0.37 (Table (Table3).3). These differences were judged to be clinically important and consequently seven items were included in the Bedside PEWS score. These items were: heart rate, systolic blood pressure, CRT, respiratory rate, respiratory effort, transcutaneous oxygen www.selleckchem.com/products/Gemcitabine-Hydrochloride(Gemzar).html saturation and oxygen therapy.Table 3The performance of alternate scoresThe maximum possible Bedside PEWS score is 26 and the minimum 0. The mean maximum score in case patients was 10.1 and the difference between the mean maximum scores of control and case patients was 6.7. The AUCROC was 0.91 with sensitivity 82% and specificity 93% at a threshold score of 8 (Figure (Figure11).Figure 1The receiver operating characteristics curve for the maximum Bedside Paediatric Early Warning System score.
Results are shown for the 11 hours ending one hour before urgent ICU admission and for 12 hours in control patients who had not clinical deterioration …ValidationComparison with retrospective nurse perceptionsFrontline nurses completed 226 surveys describing severity of illness in 168 (93%) patients, with a median of 1 (interquartile range (IQR) 1 to 2) surveys completed per case patient and 1 (1 to 1) per control patient. All nurses who were contacted consented to participate. The maximum PEWS score within the time that the surveyed nurse cared for the patient was positively correlated with their perception of the risk of clinical deterioration near or actual cardiopulmonary arrest (r = 0.536, P < 0.0001).
The correlation between the maximum Bedside PEWS score and the nurse rating of risk of near or actual cardiopulmonary arrest was -0.26 for controls (P = 0.0037), and was not significantly different from zero in case patients (P = 0.9986). The multi-variable regression analysis of the maximum score sequentially removed nurse experience (P = 0.82, r2 = 0.49), nurse patient ratio (P = 0.72, r2 = 0.49) and nurse rating of patient risk of near or actual cardiopulmonary arrest (P = 0.06, r2 = 0.51), leaving the case-control status (P < 0.0001, r2 = 0.49) as the only factor significantly associated with the maximum Bedside PEWS score. The interaction term with nurse experience and rating of patient risk of near or actual cardiopulmonary arrest was not significant.
In a logistic regression the case-control status was significantly associated with the retrospective nurse rating of patient risk of near or actual cardiopulmonary arrest (P < 0.0001, AUCROC 0.84). Multi-variable logistic regression found three variables were significantly associated with case-control status: the maximum Bedside PEWS score (P < 0.0001), the nurse-patient ratio (P = 0.028), and the nurse rating of the child's risk of near or actual cardiopulmonary arrest (P = AV-951 0.0005). The AUCROC was 0.94.