Pediatric Early Warning Score (PEWS) in predicting prognosis of critical pediatric trauma patients: a retrospective study

Background

This study aimed to compare the predictive value of Pediatric Early Warning Score (PEWS) to Pediatric Risk of Mortality-3 (PRISM-3), Pediatric Trauma Score (PTS), and Pediatric Glasgow Coma Score (pGCS) in determining clinical severity and mortality among critical pediatric trauma patients.

Method

A total of 122 patients monitored due to trauma in the pediatric intensive care unit between 2020 and 2023 were included in the study. Physical examination findings, vital parameters, laboratory values, and all scoring calculations for patients during emergency room admissions and on the first day of intensive care follow-up were recorded. Comparisons were made between two groups identified as survivors and non-survivors.

Results

The study included 85 (69.7%) male and 37 (30.3%) female patients, with an average age of 75 ± 59 months for all patients. Forty-one patients (33.6%) required Invasive Mechanical Ventilation (IMV) and 11 patients (9%) required inotropic therapy. Logistic regression analysis revealed a significant association between mortality and PEWS (p < 0.001), PRISM-3 (p < 0.001), PTS (p < 0.001), and pGCS (p < 0.001). Receiver operating characteristics curve analysis demonstrated that the PEWS score (cutoff > 6.5, AUC = 0.953, 95% CI 0.912–0.994) was highly predictive of mortality, showing similar performance to the PRISM-3 score (cutoff > 21, AUC = 0.999, 95% CI 0.995–1). Additionally, the PEWS score was found to be highly predictive in forecasting the need for IMV and inotropic therapy.

Conclusion

The Pediatric Early Warning Score serves as a robust determinant of mortality in critical pediatric trauma patients. Simultaneously, it demonstrates strong predictability in anticipating the need for IMV and inotropic therapy.