| dc.description.abstract | Background: Previously High-Flow Nasal Cannula (HFNC) was provided on Paediatric Intensive Care Units (PICU’s), currently it becomes more commonly on general wards. In order to monitor deterioration, Wilhelmina Children Hospital (WKZ) integrated Paediatric Early Warning Score (PEWS) during HFNC on the general wards. The aim of this study is to describe the implications of an alarming cut-off PEWS of ≥10, in order to identify infants at risk for PICU-transfer during HFNC.
Method: A quantitative observational descriptive longitudinal study was conducted. A retrospective cohort of infants, receiving HFNC on the general ward between 2014 and 2017, was analysed using Chi-square, sensitivity and specificity, descriptive statistics, and Pearson’s correlation coefficient. Validity of the cut-off PEWS of ≥10, protocol adherence of nursing staff and oxygen-concentrations as additional parameter were described.
Results: A significant association occurred between PICU-transfers and alarming PEWS of ≥10, p= .001. Sensitivity and specificity were 0,66 and 0,77, respectively. Of the 104 included infants, 9 PICU-transfers were identified (3 PICU-transfers related to a PEWS of ≤9, 6 to a PEWS of ≥10). Nursing staff did not scored PEWS before HFNC started, nor after 1,5 and 3 hours. However, in case they did, 50% of the infants had alarming PEWS of ≥10. Significant correlation between all PEWS and oxygen-concentrations occurred, however this was not shown in case of PEWS of ≥10.
Conclusion: Alarming PEWS of ≥10 is able to identify the risk of PICU-transfers during HFNC, despite 3 false-negative cases. In order to maintain protocol adherence of nursing staff, cut-off PEWS should not be adjusted. Therefore, we recommend that an PEWS of ≥10 during HFNC should be taken seriously by clinicians and nursing staff but a low PEWS is poor in ruling out the risk of a PICU-transfer. Follow-up research is recommended to review the discrepancy of oxygen-concentrations correlation. | |
