234 - Predicting Clinical Deterioration in Febrile Children Using the PEWS-RL Score in a Tanzanian Emergency Department

Publication Number: 1222.234

Lindsey Austin, University of California, San Francisco, School of Medicine, Oakland, CA, United States; Teresa B.. Kortz, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Jazmin M. Baez Maidana, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Scott P. Oltman, University of California, San Francisco, School of Medicine, San Diego, CA, United States

Background: Early identification of critically ill children is essential to improving outcomes, particularly in low-resource settings where advanced monitoring and clinical expertise may be limited. The Pediatric Early Warning Score-Resource Limited (PEWS-RL) is a triage tool developed to identify children at risk of clinical deterioration using routinely available clinical parameters. However, its external validation in low-resource settings remains limited.

Objective: To evaluate the ability of PEWS-RL to predict clinical deterioration within 24 hours among febrile children presenting to an emergency department (ED) of a national referral hospital in Tanzania.

Design/Methods: We conducted a secondary analysis of prospectively collected data from febrile children presenting to the emergency department of a national referral hospital in Tanzania. Clinical deterioration was defined as the occurrence of one or more of the following within 24 hours of ED presentation: bag-mask ventilation, cardiopulmonary resuscitation (CPR), non-invasive positive pressure ventilation (NIPPV), endotracheal intubation, pediatric intensive care unit (PICU) admission, use of vasoactive medications, or death. PEWS-RL scores were calculated at presentation and evaluated for predictive performance.

Results: Among 755 febrile children included in the analysis, clinical deterioration within 24 hours occurred in 23.8%. A PEWS-RL score of ≥4 optimally predicted risk of decompensation (46.8%) with high sensitivity (81.1%) and specificity (88.6%), corresponding to an area under the ROC curve of 0.91 (95% CI: 0.89-0.93). Children with a PEWS-RL score ≥4 had 27.8 times higher odds of deterioration (95% CI: 18.0-43.9; p < 0.001).

Conclusion(s): The PEWS-RL score reliably predicted clinical deterioration within 24 hours among febrile children presenting to a Tanzanian emergency department. These findings provide external validation of PEWS-RL and support its potential as a feasible, low-complexity triage tool for early identification of critically ill children in resource-limited settings. Further prospective validation and implementation studies are warranted.

Receiver operating characteristic curve


Types of Clinical Deterioration Events