Performance of pediatric early warning score and physician gestalt in predicting adverse events among Paediatric patients presenting to the emergency medicine department of a tertiary hospital in Tanzania

Abstract

ABSTRACT Background: Critically ill children are highly susceptible to adverse events if prompt interventions are not administered due to the variability of their 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 evaluate 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 prospective cohort study involved children aged 28 days to 14 years who presented to the Emergency Department at Muhimbili National Hospital from May to June 2024. Physicians estimated the likelihood of adverse events (e.g., intubation, ventilation, ICU admission, or death) using clinical gestalt, while the Pediatric Early Warning Score (PEWS) was recorded for all patients. Patients were monitored until their outcome was determined. A cut-off probability of ≥70% for clinician gestalt, based on Youden's index, and a PEWS score of ≥3 were used. Sensitivity, specificity, predictive values, and area under the curve (AUC) were calculated to assess the accuracy of both methods in predicting 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.