414 - PEWS Score and Mode of Transport from UCC to Higher Level of Care

Publication Number: 4405.414

Gabriela Lins, Nicklaus Children’s Hospital, Miami, FL, United States; Anushree Malhotra-Hans, Nicklaus Children’s Hospital, Miami, FL, United States; Keith Meyer, Nicklaus Children's Hospital, Miami, FL, United States; Michelle Blumstein, Nicklaus Children's Hospital, Miami, FL, United States; Katayoun Meyer, Nicklaus Children’s Hospital, Miami, FL, United States; Phillip Newcomm, Nicklaus Children’s Hospital, Miami, FL, United States; Balagangadhar R. Totapally, Nicklaus Children’s Hospital, Miami, FL, United States

Background: Children with acute illnesses are often seen in Urgent Care Centers (UCC). Some of the children seen in UCC require higher levels of care (HLC), necessitating timely and safe transportation. The Pediatric Early Warning Score (PEWS) is a clinical tool used to identify pediatric patients at risk of clinical deterioration, often used in emergency rooms (ER) and inpatient locations. The association of PEWS and the mode of transportation
(private vehicle (PV) vs other modes of transport (emergency medical services (EMS) or Pediatric Specialty Transport Team (PSTT)) from UCCs to HLC is not known.

Objective: To compare the PEWS scores (PMID: 22157421) and other variables in children transported from UCCs served by Nicklaus Children's Health System (NCHS) to a HLC by PV vs other modes of transport.

Design/Methods: A retrospective cross-sectional chart review study of children who were transported from NCHS UCCs to NCH main hospital (ER, Floor, ICU) or other local ERs during 2022 and 2025. Chi-square, Mann-Whitney U tests, and regression analyses were used to analyze the data.

Results: Out of 710,787 visits seen in 9 UCCs served by NCHS, 2566 (0.36%) patients were transferred to a HLC. Out of 2,566 patients, 1050 (40.9%) were transferred to NCH, and the rest to local ERs. A private vehicle was used in 1624 (64%) patients and other modes of transport were used in 942 (36%) patients (616 (24%) by EMS and 308 (12%) by PSTT). The demographic and clinical characteristics of patients with two modes of transport are presented in Table 1. A PEWS score > 0 is associated with lower odds of transportation with a private vehicle (OR: 0.15 [0.12-0.18]). AUC of ROC for PEWS and private mode transport was 0.70 (0.67-0.72; p< 0.001) with a sensitivity of 0.51 and specificity of 0.87 at PEWS 0.5 (Fig 1). Table 2 presents the adjusted odds of variables associated with the use of a private vehicle. The OR for the use of private vehicle was higher with PEWS = 0, longer driving distance to receiving facility, and fever as presenting symptom, and lower if presenting with a foreign body, trauma, or needing any therapeutic intervention or diagnostic test (Table 2).

Conclusion(s): In our study, lower PEWS scores are associated with the use of a private vehicle for transport from UCC to HLC. Private transportation is also associated with longer travel distances and shorter lengths of stay at UCC. Further studies are warranted to determine whether the PEWS score obtained at the UCC can help guide decisions regarding mode of transport, as well as its implications for patient safety and cost-effectiveness.

Table 1. Demographic and clinical characteristics of children transported by private vehicle compared to other means from Urgent Care Centers to higher levels of care
LOS =length off stay; NCH = Nicklaus Children's Hospital; PEWS= pediatric early warning score; UCC = urgent care center. Continuous variables are described as median (interquartile range), and categorical values are described as number (%).

Table 2. Regression analysis of variables associated with transportation with a private vehicle from Urgent Care Centers to higher levels of care
NCH= Nicklaus Children's Hospital; PEWS = pediatric early warning score

Fig 1. Receiver Operating Curve for PEWS vs Transportation with Private Vehicle