BMJ Paediatrics Open最新文献

{"title":"Faecal impaction in children aged 0-18 years: a systematic review and metanarrative analysis of definitions used.","authors":"Morris Gordon, Amber Balda, Samantha Arrizabalo, Vassiliki Sinopoulou, Stephanie Batarseh, Jina Shargawi, Carlo Di Lorenzo, Marc A Benninga, Merit Tabbers, Miguel Saps","doi":"10.1136/bmjpo-2024-003085","DOIUrl":"10.1136/bmjpo-2024-003085","url":null,"abstract":"<p><strong>Background: </strong>Faecal impaction is the result of functional constipation in the majority of cases. Surprisingly, a uniform definition for the term faecal impaction is lacking, leading to heterogeneity across study results.</p><p><strong>Aim: </strong>To conduct a metanarrative systematic review to ascertain how trial studies define faecal impaction among children aged 0-18 years with functional constipation.</p><p><strong>Methods: </strong>We conducted a systematic metanarrative review to uncover what criteria are used to define faecal impaction and to recommend directions for creating a globally accepted definition. A comprehensive literature search was conducted using prominent databases, including CENTRAL, MEDLINE, Embase, WHO ICTR (international clinical trials registry) and ClinicalTrials.gov. All relevant publications of RCTs on both faecal impaction and functional constipation from inception to June 2024, including children aged 0-18 years without underlying organic aetiology, were included.</p><p><strong>Results: </strong>6211 studies were screened, of which 155 were reviewed for eligibility, 76 were included in the review and five are awaiting classification. Seven studies gave an explicit definition, with three referencing a previous consensus definition. 45 studies gave an implicit definition derived from their prescreening or exclusion criteria in a larger piece of research. Clinical assessment was the most common element of definitions, with a mixture of abdominal or rectal assessments reported in 44 studies. A further six studies suggested such clinical assessments are combined with radiographs, and one study reported a definition using radiographs alone. One study reported the duration of symptoms in a definition.</p><p><strong>Conclusion: </strong>There is a clear lack of consensus for defining faecal impaction in children with functional constipation. Despite the clinical, diagnostic and prognostic importance of having a unified definition of faecal impaction, currently there seems to be no universally accepted definition.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organisation of paediatric primary care and access to emergency room: an observational study in Italy.","authors":"Letizia Bartolini, Laura Bonvicini, Romano Manzotti, Annalisa Zini, Chiara Longagnani, Massimo Quattropani, Paolo Giorgi Rossi, Giulio Formoso","doi":"10.1136/bmjpo-2024-003143","DOIUrl":"https://doi.org/10.1136/bmjpo-2024-003143","url":null,"abstract":"<p><p>Ease of access to primary care may be inversely related to non-emergency access to emergency room services (ERS). We assessed whether patients of general paediatricians working in networks have reduced the use of ERS in an Italian province. In 9 months, overall rates of visits and repeated ER visits were numerically higher for patients of solo paediatricians than for those of paediatricians working in networks. However, in our sample, the reduction of the corresponding adjusted risks was not statistically significant most of the time. Further research should assess whether organisational factors are associated with the risk of using ERS inappropriately.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of persisting symptoms after concussion in children following a traumatic brain injury: a longitudinal retrospective cohort study.","authors":"Rebecca Wilson, Joni Jackson, Kate Birnie, Sharea Ijaz, Matthew Booker, Alex Burrell, Giles Haythornthwaite, Jialan Hong, Mark D Lyttle, Lucy Pocock, Lauren J Scott, Cathy Williams, Ingram Wright, Jelena Savovic, Julie Mytton, Maria Theresa Redaniel","doi":"10.1136/bmjpo-2024-003036","DOIUrl":"10.1136/bmjpo-2024-003036","url":null,"abstract":"<p><strong>Objectives: </strong>To identify predictors of persisting symptoms after concussion (PSaC) in children, following any medically attended traumatic brain injury (TBI).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Linked primary and secondary care data from UK Clinical Practice Research Datalink and Hospital Episode Statistics.</p><p><strong>Participants: </strong>Children aged 1-17 years with a medically attended TBI between 2013 and 2017.</p><p><strong>Main outcome measure: </strong>A binary indicator of PSaC or suspected PSaC, measured using either a clinical code for PSaC or medical attendances for one or more PSaC symptoms 3-12 months after TBI.</p><p><strong>Results: </strong>We identified 137 873 children with a TBI; 4620 (3.4%) had PSaC or suspected PSaC. More females (3.8%) had PSaC than males (3.1%). Those with PSaC were older at the time of TBI compared with those without PSaC (8 vs 5.5 years). In a multivariable logistic regression model, older age (OR =1.02 per year increase in age, 95% CI 1.01 to 1.03), female sex (OR=1.20, 95% CI 1.13 to 1.28), being Asian (OR=1.37, 95% CI 1.22 to 1.54) or mixed ethnicity (OR=1.18, 95% CI 1.01 to 1.37) (compared with white ethnicity), having a history of headaches (OR=3.52, 95% CI 3.13 to 3.95), learning disabilities (OR=2.06, 95% CI 1.69 to 2.52), ADHD (OR=2.41, 95% CI 1.91 to 3.04), anxiety (OR=2.58, 95% CI 2.18 to 3.05), depression (OR=4.00, 95% CI 3.28 to 4.89) or sleep disorders (OR=2.35, 95% CI 1.99 to 2.78) were associated with increased odds of PSaC.</p><p><strong>Conclusions: </strong>These results may be used to identify children more likely to develop PSaC following a TBI and those who may benefit from targeted healthcare for PSaC symptoms. Identifying cases of PSaC in primary care data was challenging as perhaps many children do not attend services for suspected PSaC or, if they did, are not diagnosed with PSaC. Furthermore, the clinical predictors are a measure of healthcare access for these symptoms; thus, results could be influenced by patient or carer's health-seeking behaviour.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safeguarding children on Welsh roads: the 20 mph policy and the road ahead.","authors":"Samantha Turner, Theodora Pouliou, Richard Fry, Ian Walker, Ben Beck, Oliver Thwaites, Ronan A Lyons","doi":"10.1136/bmjpo-2024-003274","DOIUrl":"10.1136/bmjpo-2024-003274","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relative age as a risk factor for psychiatric diagnoses in children born preterm and to term: a cohort study.","authors":"Christine Strand Bachmann, Kari Risnes, Johan Håkon Bjørngaard, Jorun Schei, Sara Marie Nilsen, Kristine Pape","doi":"10.1136/bmjpo-2024-003186","DOIUrl":"10.1136/bmjpo-2024-003186","url":null,"abstract":"<p><strong>Objective: </strong>To assess relative age effects (how the youngest children in a school class are at increased risk compared with their older classmates) on healthcare use with psychiatric diagnoses in childhood and adolescence within preterm and term-born boys and girls.</p><p><strong>Design/setting/patients: </strong>Registry-based cohort study including individuals born in Norway from 1991 to 2012 with follow-up data from the National Patient Registry from 2008 to 2017 when they were aged between 4 and 18 years.</p><p><strong>Exposures: </strong>Relative age was defined according to birth month and grouped in four 3-month periods. Gestational age at birth (GA week+days) was categorised into preterm (GA 23+0-36+6) and term (GA 37+0-41+6).</p><p><strong>Main outcome measures: </strong>The presence of psychiatric diagnoses (any diagnosis and specific diagnosis groups according to ICD-10) in data from specialist healthcare contacts at different ages during follow-up was compared between relative age groups in preterm and term born using generalised estimating equation logistic regression analyses.</p><p><strong>Results: </strong>Of 1 109 411 individuals, 7% were born preterm. Relative age effects for psychiatric diagnosis and specific diagnosis groups were seen for both preterm and term-born boys and girls, with the strongest estimates for any psychiatric diagnosis in the relatively younger preterm girls born in October-December, compared with the relatively older preterm girls born in January-March (OR 1.43 (95% CI 1.25 to 1.63) at ages 4-10 years).</p><p><strong>Conclusions: </strong>Relative age effects were widely demonstrated for healthcare use with psychiatric diagnoses within term and preterm born, for both girls and boys. The excess risk for those born late in the year added to already existing adversity in children born preterm, emphasising the need for additional consideration related to school and societal structures.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bahir Dar Child Development Cross-Sectional Study, Ethiopia: study protocol.","authors":"Sarah K G Jensen, Kalkidan Yibeltal, Krysten North, Firehiwot Workneh, Atsede Teklehaimanot, Betelhem Haimanot Abate, Nebiyou Fasil, Tizita Lemma Melka, Theresa I Chin, Lian V Folger, Unmesha Roy Paladhi, Fred Van Dyk, Moriah E Thomason, Patricia Ellen Grant, Terrie Inder, Alemayehu Worku, Yemane Berhane, Anne Cc Lee","doi":"10.1136/bmjpo-2024-003173","DOIUrl":"10.1136/bmjpo-2024-003173","url":null,"abstract":"<p><strong>Introduction: </strong>Foundational preacademic skills are crucial for academic success and serve as predictors of socioeconomic status, income and access to healthcare. However, there is a gap in our understanding of neurodevelopmental patterns underlying preacademic skills in children across low-income and middle-income countries (LMICs). It is essential to identify primary global and regional factors that drive children's neurodevelopment in LMICs. This study aims to characterise the typical development of healthy children and factors that influence child development in Bahir Dar, Ethiopia.</p><p><strong>Methods and analysis: </strong>The Bahir Dar Child Development Study is a cross-sectional study implemented in two health centres, Shimbit and Abaymado and in Felege Hiwot Comprehensive Specialized Hospital (FHCSH) in Bahir Dar, Amhara, Ethiopia. Healthy children between 6 and 60 months of age will be recruited from the health centres during vaccination visits or via community outreach. Young children aged 6-36 months will complete the Global Scale for Early Development. A battery of paper and tablet-based assessments of neurocognitive outcomes including visual and verbal reasoning, executive functions and school readiness will be completed for children aged 48-60 months. Caregivers will respond to surveys covering sociodemographic information, the child's medical history and nutrition, and psychosocial experiences including parental stress and mental health. During a second visit, participants will undergo a low-field MRI scan using the ultra-low-field point-of-care Hyperfine MRI machine at FHCSH. Analyses will examine relationships between risk and protective factors, brain volumes and neurocognitive/developmental outcomes.</p><p><strong>Ethics and dissemination: </strong>The study is approved by the Institutional Review Boards of Addis Continental Institute of Public Health (ACIPH/lRERC/004/2023/Al/05-2024), Mass General Brigham Hospital (2022P002539) and Brown University (STUDY00000474). Findings will be disseminated via local dissemination events, international conferences and publications.</p><p><strong>Trial registeration number: </strong>NCT06648863.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute alcohol intoxication among adolescents in Italy, the Netherlands and Belgium: a cross-national hospital chart comparison study.","authors":"Hanna van Roozendaal, Louise Pigeaud, Allegra Ferrari, Loes de Veld, Stijn Verhulst, Inge Glazemakers, Jozef De Dooy, Giancarlo Icardi, Andrea Orsi, Guido Van Hal, Nico van der Lely","doi":"10.1136/bmjpo-2024-003241","DOIUrl":"10.1136/bmjpo-2024-003241","url":null,"abstract":"<p><strong>Background: </strong>Excessive drinking among adolescents in Western Europe is prevalent, posing significant health risks and societal costs. Comprehensive data on adolescent drinking patterns is crucial for developing effective prevention strategies. Data on alcohol intoxication among adolescents provide valuable insights in this context.</p><p><strong>Methods: </strong>To gain insight into the demographic and clinical characteristics of acute alcohol intoxication (AAI) across European countries, we analysed emergency department data on AAI among adolescents (aged 14-17) from 2015 to 2023 in three urban regions: Genoa (Italy), Delft (the Netherlands) and Antwerp (Belgium).</p><p><strong>Results: </strong>Out of 1826 admissions, Belgium had the highest median annual admission rate (51 per 10 000 adolescents), followed by the Netherlands (49 per 10 000) and Italy (37 per 10 000). The median age of patients was 16 years across all countries. Sex was equally distributed among Dutch patients; however, in Italy (not statistically significant, 55.6%) and Belgium (statistically significant, 56.8%), more males were admitted. The median blood alcohol concentration (BAC) was higher in the Netherlands (2.00 g/L) compared with Italy and Belgium (1.84 g/L and 1.97 g/L, respectively). This difference remained statistically significant after adjusting for confounders in a multiple linear regression model on BAC. Finally, the proportion of patients with combined drug use (10.4% of the total population) was similar across the three countries.</p><p><strong>Conclusions: </strong>This is the first international study to consolidate data on AAI in minors from multiple countries, emphasising the need for a unified European database on AAI in adolescents to enhance prevention efforts.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caregiver experiences of accessing a child developmental assessment service in a culturally diverse population in Australia: a mixed methods study.","authors":"Yvonne Teoh, Pankaj Garg, Nugroho Karyadiguna, Sinthu Vivekanandarajah, Lydia So, Romy Hurwitz, Shanti Raman","doi":"10.1136/bmjpo-2024-003003","DOIUrl":"10.1136/bmjpo-2024-003003","url":null,"abstract":"<p><strong>Background: </strong>While there is a high level of concern among parents about waiting for child developmental services, there is limited research on caregiver perspectives on accessing public developmental diagnostic services, especially for families from culturally diverse backgrounds. We aimed to explore caregiver perspectives and satisfaction after attending a Child Developmental Assessment Service (CDAS) appointment for their child in South Western Sydney, as part of a large quality improvement project.</p><p><strong>Methods: </strong>Over a 6-month period between June and December 2022, we surveyed caregivers after their child's first CDAS appointment, using an adapted caregiver questionnaire that contained Likert scale and free-text responses. We analysed the data using simple descriptive and thematic data analysis.</p><p><strong>Results: </strong>Of 107 caregiver satisfaction questionnaires completed, almost two-thirds (63%) were from culturally and linguistically diverse backgrounds. Over 90% caregivers reported a satisfaction response of 'Agree' to 'Strongly Agree', 88% felt that the assessment was suitable to their child's needs and 85% considered waiting times reasonable. The mean overall caregiver satisfaction score was 4.5 (SD 1.1). About 30% of families had doubts about their child's neurodevelopmental diagnosis. The themes identified from free-text responses were (1) positive caregiver experience; (2) clinician attributes; (3) quality of the service delivery; (4) information received. Caregivers expressed very high levels of satisfaction with the quality of service and clinicians' skills, appreciated enhanced understanding of their child's development and found the assessment helpful.</p><p><strong>Conclusions: </strong>Our study showed surprisingly high levels of caregiver satisfaction in attending a neurodevelopmental assessment service, in a culturally diverse metropolitan setting. Our findings support the importance of providing interpersonal sensitivity and family-centred practice for children with neurodevelopmental difficulties. We need to respond to the families who disagreed with the diagnostic formulation or were dissatisfied with the service, to improve the service quality, using longitudinal evaluation and more in-depth qualitative analysis.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and burden of COVID-19 in children and adolescents in Colombia: a retrospective database analysis.","authors":"Jair Arciniegas, Juan Manuel Reyes, Jhon Bolaños-López, Carlos Fernando Mendoza, Julia Spinardi, Jingyan Yang, Farzaneh Maleki, Farley Johanna Gonzalez, Carlos Bello, Ana Catalina Herrera, Omar Escobar, Andrea Constanza Rubio, Mónica García, Luz Eugenia Pérez, Jorge La Rotta, Moe Kyaw","doi":"10.1136/bmjpo-2024-003243","DOIUrl":"10.1136/bmjpo-2024-003243","url":null,"abstract":"<p><strong>Background: </strong>The burden of COVID-19 infections has been extensively studied in some parts of the world. However, in emerging economies and particularly in Latin America and Colombia, research is still incomplete, especially in the paediatric population. This study aims to investigate the burden of COVID-19 infections in children and adolescents in Colombia to understand the burden and outcomes of COVID-19.</p><p><strong>Methods: </strong>This is a retrospective database analysis of 0-17-year-old persons diagnosed with COVID-19 and given inpatient or outpatient care at a large health maintenance organisation covering 10% of the entire population from March 2020 to January 2023. Cases were confirmed by International Classification of Diseases 10th Revision codes for COVID-19 and a lab test. The incidence rates of COVID-19 cases per 100 000 persons were calculated. With a multivariate logistic regression model adjusted for demographical and clinical characteristics, the factors related to developing severe or critical COVID-19 during the study period were identified.</p><p><strong>Results: </strong>Of the 76 376 COVID-19 cases included in the analysis, the mean age was 9.8 years, about 51.5% were male, 99.6% lived in urban areas and 98.9% were unvaccinated (76.9% of the cases occurred before the vaccination of this group began on 31 October 2021). Most cases (69 528, 91%) were classified as mild, 0.9% as moderate, 8% as severe and 0.1% as critical. The most prominent comorbidities were mental health-related conditions (18.9%), chronic lung disease (13.6%) and immunocompromised condition (10.6%). 28 deaths were observed, of which 22 had at least 1 comorbidity, the most frequent being chronic lung disease and mental health conditions.</p><p><strong>Conclusion: </strong>Nearly 1 in 5 cases of COVID-19 was documented in children with underlying medical conditions. Our findings underscore the need to target children with comorbidities.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing a national Dutch PEWS system in 12 hospitals with different contexts: opportunities, challenges and implications.","authors":"Jikke Stevens, Tessa de Jong, Michèl A Willemsen, Joris Fuijkschot, Janke de Groot","doi":"10.1136/bmjpo-2025-003378","DOIUrl":"10.1136/bmjpo-2025-003378","url":null,"abstract":"<p><strong>Background: </strong>Worldwide, there is a large heterogeneity of Paediatric Early Warning Score (PEWS) systems to detect deterioration in hospitalised children timely. In the Netherlands, the Dutch PEWS was created to enhance national standardisation, incorporating a core set of vital signs and watcher signs with local adaptation strategies. The primary objective of this study was to determine factors for successful implementation. The secondary objectives were to assess the use and perceived value of local adaptation.</p><p><strong>Methods: </strong>In a multicentre study, the Dutch PEWS was implemented in 12 hospitals with different contexts ranging from University Medical Centers to general hospitals. This mixed-methods evaluation study prospectively collected data following the Plan-Do-Study-Act cycle. In preparation for implementation, local adaptation was executed, implementation strategies were formulated and baseline measurements were conducted. Post-implementation measures were performed 3, 6 and 9 months after implementation. In total, 1127 questionnaires and 171 interviews were completed with healthcare providers and 11 interviews and 3 member checks with project leaders. The protocol adherence percentage (PAP) was calculated for each hospital as an indicator for implementation.</p><p><strong>Results: </strong>The majority of the participants assessed the implementation and use of the Dutch PEWS positively. Important facilitators include reduced workload, increased confidence in achieving the objective and benefits related to utilisation on a national scale. Nationwide use facilitated further integration into training programmes and optimisation of electronic health record systems. At the same time, local adaptation was used in most hospitals and to varying extents. The overall PAP was 81% (±25%), ranging from 47% to 140%.</p><p><strong>Conclusion: </strong>This study demonstrates that successful implementation of PEWS systems is related to their design, adaptability to local contexts and nationwide utilisation. Moreover, nationwide use provides opportunities to evaluate the system across diverse contexts, thereby supporting broader implementation.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}