Need for intensive care unit admission, mortality rate and associated factors using paediatric advanced warning score (PAWS) on arrival at hospital: Hospital based prospective study

Background: Pediatric intensive care units (PICUs) are special areas of service to save the lives of children with life-threatening conditions/or critically ill children. Pediatric early warning scores can accurately identify up to 85% of children who will experience deterioration as early as 11 hours before, with specificity up to 95%. Delayed ICU admission has been reported to be associated with increase in mortality. Objective: To determine theneed for ICU admission, mortality rate and associated factorsusing pediatric advanced warning score (PAWS) on arrival at Hospital. Methodology: This was a prospective observational cohort study, conducted among pediatric patients aged 1month-14yrs arriving through Emergency department at Kilimanjaro Christian medical center. Initial PAW score was done by trained senior resident then grouped into two groups critical score of ≥4, and none critical <4. Each patient was followed up until discharge where the outcome was recorded and matched with the PAW scored.Data were analyzed through SPSS version 25; logistic and poison regression model were used to measure the association and comparison between groups was done by non-parametric 2 independent sample. Results: 310 were enrolled during study period,35.4%(n=110) were admitted in ICU. The median age was 29 and 21 months for all participants and for those admitted to ICU, respectively. 80% of ICU admission had critical PAW score on arrival, with significant association (p<0.001).There was statistically significant difference between critical score and non-criticalin need for admission Mann-Whitney test (p<0.001). Overall ICU mortality rate was 52.7%(n=58). Those who died, 86.2%(n=50) had critical score on admission, and there was statistically significance difference between critical score and non-critical in terms of mortality, Mann-Whitney test (p<0.001). Otherwise, those with critical PAW score were likely to stay longer in ICU. Conclusion: PAW score right on arrival at emergency can identify up to 80% of pediatric patient requiring ICU admission, thus maybe incorporated in ICU admission criteria in low and middle income countries. Critical PAW score on arrival have increased chance of death and staying longer in ICU.