PERFORMANCE OF PEDIATRIC EARLY WARNING SCORE AND PHYSICIAN GESTALT IN PREDICTING ADVERSE EVENTS AMONG PAEDIATRIC PATIENTS IN TANZANIA.

Abstract

ABSTRACT

Background: Critically ill children are highly susceptible to adverse events if prompt interventions are not administered due to their variability of vital signs. To anticipate such events, healthcare providers use a Pediatric Early Warning Score. In resource-limited countries, it is uncertain how accurately clinician gestalt predicts adverse events.

Aim: To compare the performance of the Pediatric Early Warning Score and clinician gestalt in predicting adverse events in pediatric patients who are triaged as emergency and priority.

Methodology: This was a prospective cohort study of children between 28 days to 14 years of age presenting to the Emergency Department at Muhimbili National Hospital from May 2024 to June 2024. Physicians were asked for their clinical gestalt probability of how likely the patient was to experience an adverse event (intubation, ventilation, use of inotropes, cardiac arrest, admission to intensive care unit/high dependent unit, transfer from ward to intensive care unit, death at the emergency department). Pediatric Early Warning Score was determined using the score chart and recorded for all patients. For physician gestalt probability, a cut-off was determined using a receiver operating curve, and based on Youdens’ index, a probability of ≥70% maximized sensitivity and specificity, and this estimate was used as a cut-off to define a physician’s prediction of the high probability of an adverse event to occur. For the Pediatric Early Warning Score, a cut-off of ≥3 was used. Sensitivity, specificity, positive and negative predictive values, and the area under the curve were calculated to evaluate each test’s ability to predict adverse events.

Results: A total of 250 children were enrolled. Physician gestalt had an area under the curve of 0.964 (95% CI, 0.936-0.992). An optimal cut-off probability of ≥70% predicted the occurrence of adverse events in 87.8% of patients and correctly identified those who did not have adverse events 94.8% of the time. Pediatric Early Warning Score could detect the occurrence of adverse events with a sensitivity of 80.0% and identify those who did not have adverse events in 79.5% of cases with area under the curve=0.869 (95% CI 0.809 to 0.930). A comparison of the two tests yielded a statistical significance in their specificity.

Conclusion: Physician gestalt was significantly associated with adverse events occurrence prediction than Pediatric Early Warning Score. However, a Pediatric Early Warning Score can also be used in the Emergency Department.