The researchers showed that the people who provide high-quality treatment know that escalation and de-escalation are integral parts of their work and must be coordinated with patients’ actual medical conditions. This research aimed to characterize care escalation in a cohort of pediatric inpatients with acute deterioration of their clinical condition in connection to the occurrence and timing of admission to a Pediatric Intensive Care Unit (PICU). From the beginning of 2018 to the end of the year. For this study, they included only pediatric patients: Children and adolescents who were admitted to a pediatric ward (as opposed to the intensive care unit), were under the age of 18 at the time of admission, and had 2 or more Bedside-Paediatric-Early-Warning-System (BedsidePEWS) scores 7 recorded at a distance of at least 1 hour and for a period of 4 h during admission. The primary outcome was the 24-hour disposition, which was defined as either admission to the pediatric intensive care unit (PICU) or an inpatient ward stay within 24 hours after enrollment. The researchers created an 8-point scale, which they called the Escalation Index (EI), to assess the escalation of care. Following the patient’s 1st eligibility determination, the EI was computed every 6 hours. Quantile and logistic regression models with many variables were employed for the analysis. There were a total of 574 EI computed scores among the 228 episodes. In 129 (57%) cases, the patient was sent to the ward for the next 24 hours, whereas in 99 (43%) cases, they were sent to the PICU. Compared to patients who remained on the ward for more than 24 hours, those admitted to the PICU had higher top EI scores [median (IQR) 6 (5-7) vs. 4 (3-5), P<0.001] and initial Bedside PEWS scores [median (IQR) 10(8-13) vs. 9 (8-11), P=0.02], lower rates of chronic disease [n=62 (63%) vs. n=127] (98%), P<0.0001], over the preceding 24 hours, the EI increased in patients who were subsequently admitted to the PICU or experienced a cardiac arrest at a rate of 0.53 per 6-hour interval (95%) confidence interval [CI]: 0.37 to 0.70, P<0.001), while it decreased in patients who remained on the wards at a rate of 0.25 per 6-hour interval (95% CI: -0.36-0.15, P<0.001).

Source: bmcpediatr.biomedcentral.com/articles/10.1186/s12887-022-03555-0