Scholarlink

Background <p>Pediatric patients present to the emergency departments (EDs) with a wide range of clinical manifestations, ranging from mild to severe. A systematic approach is crucial to identify those at high risk of deterioration. However, the predictive value of such predictors remains unclear.</p> Objectives <p>Our study aims to evaluate different mortality predictors used in pediatric emergency departments (PEDs) regarding the diagnostic accuracy metrics, including sensitivity, specificity, and diagnostic odds ratio.</p> Methods <p>We comprehensively searched multiple databases and included all cohort studies, case-control studies, and randomized controlled trials from January 2000 to December 2024 with pediatric patients (aged 0–18 years) presenting to PEDs, where mortality predictors were used to assess for in-ED and short-term post-ED mortality. We employed a bivariate random-effects model for data synthesis and analysis to calculate pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) values.</p> Results <p>329 Pediatric Early Warning Score (PEWS) thresholds were analyzed, with the model-derived optimal cutoff 2.189 (AUC) = 0.70; 95% CI: 0.63 to 0.76), high pooled sensitivity (0.95, 95% CI: 0.72 to 0.80) and specificity (0.93, 95% CI: 0.62 to 0.80). In addition, A strong negative predictive value (NPV = 0.0006) and modest positive predictive value (PPV = 0.0003) were noted. Heterogeneity was significant (I²&gt;99%), driven by PEWS versions and clinical settings. PEWS implementation reduced mortality without increasing ICU admissions in resource-limited settings.</p> Conclusions <p>PEWS is a good exclusion tool for those at low mortality risk. However, a comprehensive approach with clinical judgment is needed for the risk assessment of high-risk pediatrics.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Mortality predictors in pediatric emergency department presentations: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年9月26日

查看全文
  • Mohammed Alsabri,
  • Mohamed A. ELKarargy,
  • Israa Magdy Ata,
  • Mostafa A. Khalifa,
  • Abdulrahman Khaldoon Hamid,
  • Ahmed Bostamy Elsnhory,
  • Omar Ahmed Abdelwahab,
  • Sarah Urbon

摘要

Background

Pediatric patients present to the emergency departments (EDs) with a wide range of clinical manifestations, ranging from mild to severe. A systematic approach is crucial to identify those at high risk of deterioration. However, the predictive value of such predictors remains unclear.

Objectives

Our study aims to evaluate different mortality predictors used in pediatric emergency departments (PEDs) regarding the diagnostic accuracy metrics, including sensitivity, specificity, and diagnostic odds ratio.

Methods

We comprehensively searched multiple databases and included all cohort studies, case-control studies, and randomized controlled trials from January 2000 to December 2024 with pediatric patients (aged 0–18 years) presenting to PEDs, where mortality predictors were used to assess for in-ED and short-term post-ED mortality. We employed a bivariate random-effects model for data synthesis and analysis to calculate pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) values.

Results

329 Pediatric Early Warning Score (PEWS) thresholds were analyzed, with the model-derived optimal cutoff 2.189 (AUC) = 0.70; 95% CI: 0.63 to 0.76), high pooled sensitivity (0.95, 95% CI: 0.72 to 0.80) and specificity (0.93, 95% CI: 0.62 to 0.80). In addition, A strong negative predictive value (NPV = 0.0006) and modest positive predictive value (PPV = 0.0003) were noted. Heterogeneity was significant (I²>99%), driven by PEWS versions and clinical settings. PEWS implementation reduced mortality without increasing ICU admissions in resource-limited settings.

Conclusions

PEWS is a good exclusion tool for those at low mortality risk. However, a comprehensive approach with clinical judgment is needed for the risk assessment of high-risk pediatrics.