Parental preference and perspectives on continuous pulse oximetry in infants and children with bronchiolitis

Analysis of the accuracy of disease prediction in pediatric ward patients based on the modified early warning score for children: A randomized controlled trial

Background

Due to their young age and limited ability to communicate, pediatric patients in internal medicine wards are at risk of nursing assessment errors, which can lead to adverse events and disputes.

Objective

To explore the application effect of modified pediatric early warning score (PEWS) in the early identification of critically ill children in pediatric general wards.

Design

A single-blind, two-arm randomized controlled trial was conducted using a convenience sampling method.

Methods

A study was conducted on 300 pediatric inpatients admitted to the pediatric ward of a tertiary hospital in Guangdong Province between June 2021 and December 2023. The patients were randomly divided into an observation group (150 cases) and a control group (150 cases) using a random number table. The control group received standard treatment based on medical orders, along with routine basic and specialized nursing care. The observation group received an intervention combining the PEWS with a graded nursing management model. The PEWS scores of the observation group were analyzed upon admission, and the value of PEWS in assessing the severity of illness was evaluated using a receiver operating characteristic (ROC) curve. The study also compared treatment outcomes, complication rates, mortality, and parental satisfaction between the two groups.

Results

The observation group showed significantly lower mortality, complication rates, length of hospital stay, and hospitalization costs compared to the control group (P < 0.05). Additionally, parental satisfaction in the observation group was significantly higher than in the control group (P < 0.05). When using the need for nursing intervention in critically ill patients as a predictive indicator, a modified PEWS score of ≥1 point was identified as the threshold for distinguishing critically ill patients who require nursing intervention. The area under the curve (AUC) was 0.91, with a sensitivity of 92.1 %, a specificity of 75.4 %, and a Youden index of 0.675.

Conclusion

As an effective tool for assessing patient conditions, the probability of receiving nursing care significantly increases for patients with a modified PEWS score above 1. The modified PEWS is valuable for early identification of illness and assessing changes in patient conditions. It enables timely recognition of deterioration and the provision of personalized nursing interventions, thereby reducing the incidence of complications in critically ill patients, preventing further deterioration, shortening hospital stays, and lowering hospitalization costs, ultimately improving parental satisfaction. This approach is worth promoting.

Utility and Impact Analysis of Inpatient Pediatric Physiologic Monitoring

This study aimed to study the practice and effect of monitoring hospitalized pediatric patients in terms the length of stay (LOS). We have performed a prospective, observational study of pediatric patients in the general ward from October to December 2016. We have recorded the use of cardiac monitor, pulse oximeter, or both, and as per physician order at patient admission. We have studied the proportions of monitoring in different patient groups. We have applied a linear regression model to investigate the relationship between LOS and cardiopulmonary monitoring, orders, and medical complexity. Among 399 patients, patients with cardiac and pulse oximeter monitoring with orders were 68 and 82%, respectively. The pulmonary group had more monitoring than the neurology group of patients. LOS was shorter in patients without monitoring; the median difference for the cardiac monitoring was one day (interquartile range [IQR] = 1), and the pulse oximeter was 0.5 days (IQR = 1). Cardiac monitoring order increased LOS by 22% (95% confidence interval [CI]: 0.5, 48%) and complex past medical history increased it by 25% (95% CI: 4, 51%). Our study highlights the variable practice in using monitors, emphasizing a standardized approach. The judicious use of monitoring may reduce prolonged hospitalization. Selective use of physiologic monitoring of ill-appearing or at risk of hypoxemia or cardiac dysrhythmia will reduce overuse.

Family Perspectives on Continuous Monitor Use in a Children's Hospital: A Qualitative Study

OBJECTIVES

Alarms from continuous cardiorespiratory and pulse oximetry monitors may contribute to parental anxiety and poor sleep during hospitalization, yet families also may find monitoring reassuring. Our objective was to understand how families perceive the utility, benefits, and harms of continuous monitoring.

METHODS

In this single-center qualitative study, we used semistructured interviews and direct observation. We enrolled families of patients of a variety of ages and clinical diagnoses. We extracted patient demographic information (age, diagnosis) from the health record. Semistructured interviews were recorded and transcribed. Detailed field notes were taken during observations. We used an inductive thematic approach to develop and refine codes that informed the development of themes.

RESULTS

We recruited 24 families and conducted 23 interviews and 9 observation sessions. Respiratory conditions (eg, bronchiolitis, asthma) were the most common reason for hospitalization. The hospitalized children covered a range of ages: <4 weeks (16%), 4 weeks to 6 months (20%), 7 months to 5 years (44%), and >5 years (20%); 55% had previously been hospitalized. Families expressed varying degrees of understanding the utility of monitors and often conducted their own assessments before notifying staff about alarms. Families expected monitoring, including negative effects like sleep disruption, as part of hospitalization. Families perceived the benefit of monitoring in context of previous hospital experiences, often seeing less benefit and worrying less about alarms in subsequent hospitalizations.

CONCLUSIONS

Family members continue to find reassurance from cardiorespiratory monitoring despite evidence that it offers limited benefit outside of the ICU setting. Parental perspectives should be addressed in future deimplementation efforts.

Accuracy and Monitoring of Pediatric Early Warning Score (PEWS) Scores Prior to Emergent Pediatric Intensive Care Unit (ICU) Transfer: Retrospective Analysis

BACKGROUND

Current approaches to early detection of clinical deterioration in children have relied on intermittent track-and-trigger warning scores such as the Pediatric Early Warning Score (PEWS) that rely on periodic assessment and vital sign entry. There are limited data on the utility of these scores prior to events of decompensation leading to pediatric intensive care unit (PICU) transfer.

OBJECTIVE

The purpose of our study was to determine the accuracy of recorded PEWS scores, assess clinical reasons for transfer, and describe the monitoring practices prior to PICU transfer involving acute decompensation.

METHODS

We conducted a retrospective cohort study of patients ≤21 years of age transferred emergently from the acute care pediatric floor to the PICU due to clinical deterioration over an 8-year period. Clinical charts were abstracted to (1) determine the clinical reason for transfer, (2) quantify the frequency of physiological monitoring prior to transfer, and (3) assess the timing and accuracy of the PEWS scores 24 hours prior to transfer.

RESULTS

During the 8-year period, 72 children and adolescents had an emergent PICU transfer due to clinical deterioration, most often due to acute respiratory distress. Only 35% (25/72) of the sample was on continuous telemetry or pulse oximetry monitoring prior to the transfer event, and 47% (34/72) had at least one incorrectly documented PEWS score in the 24 hours prior to the event, with a score underreporting the actual severity of illness.

CONCLUSIONS

This analysis provides support for the routine assessment of clinical deterioration and advocates for more research focused on the use and utility of continuous cardiorespiratory monitoring for patients at risk for emergent transfer.

Parental Perspectives on Continuous Pulse Oximetry Use in Bronchiolitis Hospitalizations

BACKGROUND

Because of the impact of continuous pulse oximetry (CPOX) on the overdiagnosis of hypoxemia in bronchiolitis, the American Academy of Pediatrics and the Choosing Wisely campaign have issued recommendations for intermittent monitoring. Parental preferences for monitoring may impact adoption of these recommendations, but these perspectives are poorly understood.

METHODS

Using this cross-sectional survey, we explored parental perspectives on CPOX monitoring before discharge and 1 week after bronchiolitis hospitalizations. During the 1-week call, half of the participants were randomly assigned to receive a verbal statement on the potential harms of CPOX to determine if conveying the concept of overdiagnosis can change parental preferences on monitoring frequency. An aggregate variable measuring favorable perceptions of CPOX was created to determine CPOX affinity predictors.

RESULTS

In-hospital interviews were completed on 357 patients, of which 306 (86%) completed the 1-week follow-up. Although 25% of parents agreed or strongly agreed that hospital monitors made them feel anxious, 98% agreed that the monitors were helpful. Compared to other vital signs, respiratory rate (87%) and oxygen saturation (84%) were commonly rated as "extremely important." Providing an educational statement on CPOX comparatively decreased parental desire for continuous monitoring (40% vs 20%; P < .001). Although there were no significant predictors of CPOX affinity, the effect size of the educational intervention was higher in college-educated parents.

CONCLUSIONS

Parents find security in CPOX. A brief statement on the potential harms of CPOX use had an impact on stated monitoring preferences. Parental perspectives are important to consider because they may influence the adoption of intermittent monitoring.