[Early warning scores of clinical deterioration in pediatric patients: a literature review]

. Early warning scores for clinical deterioration in pediatric patients: a literature review.

INTRODUCTION

An early recognition of clinical worsening (the manifestation of signs and symptoms resulting in physiological instability) in pediatric inpatients may prevent the evolution towards cardiorespiratory arrest. In recent decades, several tools known as PEWS (Pediatric Early Warning Scores), have been developed, aiming to reduce in-hospital morbidity and mortality.

OBJECTIVE

To describe efficacy, sensitivity and specificity of the available tools for early detection of clinical worsening in children, based on literature review.

METHODS

Systematic review through the consultation of PubMed and Google Scholar, cross-combining Mesh terms and free text words.

RESULTS

Out of 266 analysed papers, 34 were included in this review: 23 retrospective observational studies, 8 reviews, 1 reliability study, and 2 pilot studies. Overall, 23 main PEWS with sufficient evidence of efficacy were described (11 track and trigger and 12 aggregate). Ranges of sensibility and specificity were available only for 18 PEWS. It is not possible to recognize a gold standard, however, some PEWS are better in terms of validity and efficacy in different clinical settings. Internationally, the BPEWS (Brighton Pediatric Early Warning Score) is the most commonly adopted tool, able to identify clinical worsening of in-hospital children almost 11 hours before cardiac arrest.

CONCLUSIONS

Although with limited evidence, validated PEWS have shown good ability to prevent the risk of clinical worsening by reducing adverse events. Further studies and greater standardization according to the clinical context are still needed.

[Premature departure from pediatric emergency department: retrospective analysis and preventive strategies.]

. Premature departure from pediatric emergency department: retrospective analysis and preventive strategies.

INTRODUCTION

The overcrowding of Emergency Departments (EDs) is a major cause of increased waiting time for the medical evaluation and dissatisfaction of children and their families, who often decide to leave before the visit is completed.

AIM

To describe the characteristics of children who leave a second-level Pediatric ED before the medical examination.

METHODS

Retrospective descriptive analysis of children who leave before the medical evaluation at the ED of the Regina Margherita Children's Hospital of Turin, Italy between June and November 2018. Data were obtained from the Hospital's informatic registry.

RESULTS

1351 children left the ED during the study period (6.7% of total visits); 9 of them (0.7%) had received a high triage priority code. The highest leaving rate was recorded in November, on the evening-slot and in children ageing 1-10 years. The average and median waiting time of those who left the ED before the medical examination were respectively 131 and 124 minutes. Fever and gastrointestinal problems were the most frequent reasons of access. Overall, 19.8% of children received nursing care during the triage. The revolving door rate was 6.0%.

CONCLUSION

Low priority of urgency, long waiting times, access during periods of increased influx and the age between 1 and 10 years were major factors leading to leave Pediatric ED before the medical evaluation. Further studies are needed to investigate how many early leavings are due to ineffective nursing in the triage setting.

[Not Available]

BACKGROUND

Electronic cigarette smoking is spreading among health care professionals. E-cigarette smoke effects on health are not known, especially long-term effects.

AIM

The aim of this study was to investigate the phenomenon of electronic cigarettes as regards smoking habits, knowledge and opinions of health care professionals.

METHODS

A multicentre cross-sectional descriptive study was conducted by administering an online questionnaire to all the health care professionals employed in two hospitals.

RESULTS

The population included 800 employees. More than half (66.8%) of respondents believed the e-cigarette is potentially harmful and capable of attracting young people to smoking and 38.8% of respondents believed that it can serve to stop smoking. The male gender was statistically associated with tobacco and e-cigarette smoking (p=0.034). The electronic cigarette was smoked little at the work place. The population studied did not have any specific knowledge about e-cigarettes and asked for specific training; the population knew the ban on the sale of e-cigarettes to underaged and emphasized the importance of specific management guidelines.

CONCLUSIONS

The results of the study show the predominantly negative opinion of health professionals concerning the use of electronic cigarette. Moreover, the study results contributed to an improvement of the smoking policies in the hospitals studied.