Assessing acutely ill children in general practice using the National PEWS and LqSOFA clinical scores: a retrospective cohort study

Clark, Amy, Cannings-John, Rebecca ORCID: https://orcid.org/0000-0001-5235-6517, Carrol, Enitan D., Thomas-Jones, Emma ORCID: https://orcid.org/0000-0001-7716-2786, Sefton, Gerri, Hay, Alastair D., Butler, Christopher and Hughes, Kathryn ORCID: https://orcid.org/0000-0002-8099-066X 2024. Assessing acutely ill children in general practice using the National PEWS and LqSOFA clinical scores: a retrospective cohort study. British Journal of General Practice

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Abstract

Background: Clinical tools are needed in general practice to help identify seriously ill children. The Liverpool quick Sequential Organ Failure Assessment (LqSOFA) was validated in an Emergency Department and performed well. The National Paediatric Early Warning score (PEWS) has been introduced in hospitals throughout England with hopes for implementation in general practice. Aim: To validate the LqSOFA and National PEWS in general practice. Design/Setting: Secondary analysis of 6,703 children <5 years presenting to 225 general practices in England and Wales with acute illnesses, linked to hospital data. Method: Variables from the LqSOFA and National PEWS were mapped onto study data to calculate score totals. A primary outcome of admission within two days of GP consultation was used to calculate sensitivity, specificity, negative predictive values (NPV), positive predictive values (PPV) and area-under-the-curve (AUC). Results: 104/6,703 children were hospitalised within two days (pre-test probability 1.6%). The sensitivity of the LqSOFA was 30.6% (95% confidence interval 21.8% - 41.0%), with a specificity of 84.7% (83.7% - 85.6%), PPV of 3.0% (2.1% – 4.4%), NPV of 98.7% (98.4% - 99.0%), and AUC of 0.58 (0.53 - 0.63). The sensitivity of the National PEWS was 81.0% (71.0% - 88.1%), with a specificity of 32.5% (31.2% - 33.8%); PPV of 1.9% (1.5% - 2.5%); NPV of 99.1% (98.4% - 99.4%) and AUC of 0.66 (0.59 - 0.72). Conclusion: Although the NPVs appear useful, due to low pre-test probabilities rather than discriminative ability, neither tool accurately identified hospitalisations. Unconsidered use by GPs could result in unsustainable referrals.

Item Type:	Article
Status:	In Press
Schools:	Medicine Centre for Trials Research (CNTRR)
Publisher:	Royal College of General Practitioners
ISSN:	0960-1643
Funders:	Health and Care Research Wales
Date of First Compliant Deposit:	23 April 2024
Date of Acceptance:	9 April 2024
Last Modified:	01 May 2024 01:31
URI:	https://orca.cardiff.ac.uk/id/eprint/168243

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