Acurácia de dois escores pediátricos de alerta precoce de deterioração clínica no contexto brasileiro
DOI:
https://doi.org/10.4025/ciencuidsaude.v23i0.69249Palavras-chave:
Escore de Alerta Precoce, Deterioração clínica, Enfermagem Pediátrica, Sensibilidade e EspecificidadeResumo
Objetivo: comparar a acurácia e a reprodutibilidade do Escore Pediátrico de Alerta (EPA) e da versão brasileira do Brighton Paediatric Early Warning Score (BPEWS-Br) na identificação de sinais de deterioração clínica no contexto brasileiro. Método: estudo de acurácia de teste diagnóstico, realizado em um hospital materno-infantil de grande porte, com 240 crianças e adolescentes de 0 a 15 anos, de outubro de 2018 a maio de 2019. Os instrumentos para coleta foram o BPEWS, o EPA e os critérios da avaliação clínica primária da criança gravemente doente, recomendados pela American Heart Association como padrão de referência. Os dados foram analisados no MedCalc® Statistical Software, version 20.007, para estimar indicadores de acurácia e concordância entre os escores. Resultados: o EPA variou de 0 a 7 e o BPEWS-Br de 0 a 8. Considerando um escore ≥ 3, o EPA obteve prevalência de deterioração de 19,5%, o BPEWS-Br de 16,7% e o padrão de referência de 22,1%. As áreas sob as Curvas ROC do BPEWS-Br e do EPA se mostraram praticamente iguais, de 93,5% (IC: 90 – 97) e 93,6% (IC: 89,8 – 97,4), respectivamente, o que evidencia alta acurácia dos testes. O Ãndice Kappa entre os escores foi de 0,879 (IC 95%: 0,845 a 0,912), mostrando alta concordância. Conclusão: os indicadores de acurácia e reprodutibilidade do BPEWS-Br e do EPA foram elevados.
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Referências
1. Ball S, Parkinson S, Marjanovic S. Paediatric Early Warning Systems: a scoping study: lessons from a rapid review. Santa Monica, CA: RAND Corporation, 2021. Available from: https://www.rand.org/pubs/research_reports/RRA1105-1.html
2. Miranda JOF, Camargo CL, Sobrinho CLN, Pinho PS, Oliveira TL. Factors associated with the clinical deterioration recognized by an early warning pediatric score. Texto Contexto Enferm 2020; 29:e20180348. DOI: https://doi.org/10.1590/1980-265X-TCE-2018-0348
3. Rosman SL, Daneau Briscoe C, Rutare S, McCall N, Monuteaux MC, Unyuzumutima J, et al. (2022) The impact of pediatric early warning score and rapid response algorithm training and implementation on interprofessional collaboration in a resource-limited setting. PLoS ONE 17(6): e0270253. https://doi.org/10.1371/journal.pone.0270253
4. Monaghan A. Detecting and managing deterioration in children. Paediatr Nurs 2005; 17:32–5. DOI: https://journals.rcni.com//doi/abs/10.7748/paed2005.02.17.1.32.c964
5. Romaine ST, Sefton G, Lim E, Nijman RG, Bernatoniene J, Clark S et al. Performance of seven different paediatric early warning scores to predict critical care admission in febrile children presenting to the emergency department: a retrospective cohort study. BMJ Open. 2021 May 4;11(5):e044091. DOI: https://doi.org/10.1136/bmjopen-2020-044091
6. Roland D, Stilwell PA, Fortune PM, John Alexander, J, Clark SJ, Kenny S. Case for change: a standardised inpatient paediatric early warning system in England. Arch Dis Child 2021;106:648–651. DOI: https://doi.org/10.1136/archdischild-2020-320466
7. Groot JF, Damen N, de Loos E, Van de Steeg L, Koopmans L, Rosias P et al. Implementing paediatric early warning scores systems in the Netherlands: future implications. BMCPediatr. 2018; Apr 6 18(1):128. DOI: https://doi.org/10.1186/s12887-018-1099-6
8. Oliveira TL, Miranda JO, Sobrinho CL, Mendoza RF, Monaghan AP, Alencar AA. Development and content validation of the Pediatric Alert Score. Rev Soc Bras Enferm Ped 2021; 21(2): 91. DOI: http://dx.doi.org/10.31508/1676-379320210014
9. Oliveira TL, Miranda JFO, Monaghan AP, Silva RC, Santana AKA, Silva MV, Bessa Junior J et al. Pediatric Alert Score (EPA) performance in clinical deterioration. Acta Paul Enferm 2023;36:eAPE00872. DOI: https://doi.org/10.37689/acta-ape/2023AO00872
10. Cohen JF, Korevaar DA, Altman DG, Bruns DE, Gatsonis CA, Hooft L et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open. 2016; 6:e012799. DOI: https://doi.org/10.1136/bmjopen-2016-012799
11. Diaz JA, Werka HMJ, Capp E, Nienov OH. Correlações, risco, razão de chances e avaliação de testes diagnósticos. In: Capp E, Nienov OH. Bioestatística quantitativa aplicada. Porto Alegre: UFRGS, 2020. 177-196 p.
12. American Heart Association. Abordagem sistemática à criança gravemente doente. In: American Heart Association. Suporte avançado de vida em pediatria manual do profissional. Estados Unidos da América: Orora Visual. 2021. 37-69.
13. Elencwajg M, Grisolía NA, Meregalli C, Montecuco MA, Montecucoa MA, Montiela MV, Rodríguez, GM et al. Usefulness of an early warning score as an early predictor of clinical deterioration in hospitalized children. Arch Argent Pediatr. 2020; 118(6):399-404. Available from: https://www.sap.org.ar/docs/publicaciones/archivosarg/2020/v118n6a08.pdf
14. Duraisamy R, Vanaja J, Samy AP, Balasubramaniam B, Palanisamy S. Validation of Brighton pediatric early warning score for predicting clinical deterioration in the emergency department. Indian J Child Health. 2021; June 14. DOI: https://doi.org/10.32677/IJCH.2021.v08.i06.003
15. Adshead N, Thomson R. Use of a paediatric early warning system in emergency departments. Emerg Nurse. 2009;17(1):22-5. DOI: http://doi.org/10.7748/en2009.04.17.1.22.c6984
16. Duraisamy R, Balasubramanian B, Palanisamy S. Utility of Pediatric Early Warning Scoring System in Predicting Clinical Deterioration in Children: A Review. SBV Journal of Basic, Clinical and Applied Health Science. 2019; July–September 2(3): 115-118. DOI: https://doi.org/10.5005/jp-journals-10082-02221
17. Alves VA, Milbrath, VM, Nunes NJS, Gabatz RIB. Segurança do paciente em unidade de terapia intensiva neonatal: revisão integrativa. Ciência, Cuidado E Saúde. 2020. 19. DOI: https://doi.org/10.4025/ciencuidsaude.v19i0.49984
18. Agulnik A, Malone S, Puerto-Torres M, Gonzalez-Ruiz A, Vedaraju Y, Wang H et al. Reliability and validity of a Spanish-language measure assessing clinical capacity to sustain Paediatric Early Warning Systems (PEWS) in resource-limited hospitals. BMJ Open 2021;11:e053116. DOI: https://doi.org/10.1136/bmjopen-2021-053116
19. Van Der Fluit KS, Boom MC, Brandao MB, Lopes GD, Barreto PG, Leite DCF, et al.
How to implement a PEWS in a resource-limited setting: A quantitative analysis of the bedside-PEWS implementation in a hospital in northeast Brazil. Trop Med Int Health. 2021;26:1240–1247. https://doi.org/10.1111/tmi.13646
20. Miranda JO, Camargo CL, Sobrinho CLN, Oliveira TL, Matos AC, Portela DS. Reproducibility and Applicability of a Pediatric Score of Clinical Deterioration Warning. Rev Min Enferm, 2019; 23: 1-6. DOI: https://doi.org/10.5935/1415-2762.20190003
21. Conselho Regional de Enfermagem de São Paulo. Câmara técnica. Competência para aplicação e avaliação de escalas, escores e índices pediátricos na equipe de enfermagem. Parecer Coren-SP Nº 009/2021. Available from: https://portal.coren-sp.gov.br/wp-content/uploads/2021/04/Parecer_009_2021_Competencia-aplicacao-avaliacao-de-escalas-escores-indices-pediatricos.pdf
2. Miranda JOF, Camargo CL, Sobrinho CLN, Pinho PS, Oliveira TL. Factors associated with the clinical deterioration recognized by an early warning pediatric score. Texto Contexto Enferm 2020; 29:e20180348. DOI: https://doi.org/10.1590/1980-265X-TCE-2018-0348
3. Rosman SL, Daneau Briscoe C, Rutare S, McCall N, Monuteaux MC, Unyuzumutima J, et al. (2022) The impact of pediatric early warning score and rapid response algorithm training and implementation on interprofessional collaboration in a resource-limited setting. PLoS ONE 17(6): e0270253. https://doi.org/10.1371/journal.pone.0270253
4. Monaghan A. Detecting and managing deterioration in children. Paediatr Nurs 2005; 17:32–5. DOI: https://journals.rcni.com//doi/abs/10.7748/paed2005.02.17.1.32.c964
5. Romaine ST, Sefton G, Lim E, Nijman RG, Bernatoniene J, Clark S et al. Performance of seven different paediatric early warning scores to predict critical care admission in febrile children presenting to the emergency department: a retrospective cohort study. BMJ Open. 2021 May 4;11(5):e044091. DOI: https://doi.org/10.1136/bmjopen-2020-044091
6. Roland D, Stilwell PA, Fortune PM, John Alexander, J, Clark SJ, Kenny S. Case for change: a standardised inpatient paediatric early warning system in England. Arch Dis Child 2021;106:648–651. DOI: https://doi.org/10.1136/archdischild-2020-320466
7. Groot JF, Damen N, de Loos E, Van de Steeg L, Koopmans L, Rosias P et al. Implementing paediatric early warning scores systems in the Netherlands: future implications. BMCPediatr. 2018; Apr 6 18(1):128. DOI: https://doi.org/10.1186/s12887-018-1099-6
8. Oliveira TL, Miranda JO, Sobrinho CL, Mendoza RF, Monaghan AP, Alencar AA. Development and content validation of the Pediatric Alert Score. Rev Soc Bras Enferm Ped 2021; 21(2): 91. DOI: http://dx.doi.org/10.31508/1676-379320210014
9. Oliveira TL, Miranda JFO, Monaghan AP, Silva RC, Santana AKA, Silva MV, Bessa Junior J et al. Pediatric Alert Score (EPA) performance in clinical deterioration. Acta Paul Enferm 2023;36:eAPE00872. DOI: https://doi.org/10.37689/acta-ape/2023AO00872
10. Cohen JF, Korevaar DA, Altman DG, Bruns DE, Gatsonis CA, Hooft L et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open. 2016; 6:e012799. DOI: https://doi.org/10.1136/bmjopen-2016-012799
11. Diaz JA, Werka HMJ, Capp E, Nienov OH. Correlações, risco, razão de chances e avaliação de testes diagnósticos. In: Capp E, Nienov OH. Bioestatística quantitativa aplicada. Porto Alegre: UFRGS, 2020. 177-196 p.
12. American Heart Association. Abordagem sistemática à criança gravemente doente. In: American Heart Association. Suporte avançado de vida em pediatria manual do profissional. Estados Unidos da América: Orora Visual. 2021. 37-69.
13. Elencwajg M, Grisolía NA, Meregalli C, Montecuco MA, Montecucoa MA, Montiela MV, Rodríguez, GM et al. Usefulness of an early warning score as an early predictor of clinical deterioration in hospitalized children. Arch Argent Pediatr. 2020; 118(6):399-404. Available from: https://www.sap.org.ar/docs/publicaciones/archivosarg/2020/v118n6a08.pdf
14. Duraisamy R, Vanaja J, Samy AP, Balasubramaniam B, Palanisamy S. Validation of Brighton pediatric early warning score for predicting clinical deterioration in the emergency department. Indian J Child Health. 2021; June 14. DOI: https://doi.org/10.32677/IJCH.2021.v08.i06.003
15. Adshead N, Thomson R. Use of a paediatric early warning system in emergency departments. Emerg Nurse. 2009;17(1):22-5. DOI: http://doi.org/10.7748/en2009.04.17.1.22.c6984
16. Duraisamy R, Balasubramanian B, Palanisamy S. Utility of Pediatric Early Warning Scoring System in Predicting Clinical Deterioration in Children: A Review. SBV Journal of Basic, Clinical and Applied Health Science. 2019; July–September 2(3): 115-118. DOI: https://doi.org/10.5005/jp-journals-10082-02221
17. Alves VA, Milbrath, VM, Nunes NJS, Gabatz RIB. Segurança do paciente em unidade de terapia intensiva neonatal: revisão integrativa. Ciência, Cuidado E Saúde. 2020. 19. DOI: https://doi.org/10.4025/ciencuidsaude.v19i0.49984
18. Agulnik A, Malone S, Puerto-Torres M, Gonzalez-Ruiz A, Vedaraju Y, Wang H et al. Reliability and validity of a Spanish-language measure assessing clinical capacity to sustain Paediatric Early Warning Systems (PEWS) in resource-limited hospitals. BMJ Open 2021;11:e053116. DOI: https://doi.org/10.1136/bmjopen-2021-053116
19. Van Der Fluit KS, Boom MC, Brandao MB, Lopes GD, Barreto PG, Leite DCF, et al.
How to implement a PEWS in a resource-limited setting: A quantitative analysis of the bedside-PEWS implementation in a hospital in northeast Brazil. Trop Med Int Health. 2021;26:1240–1247. https://doi.org/10.1111/tmi.13646
20. Miranda JO, Camargo CL, Sobrinho CLN, Oliveira TL, Matos AC, Portela DS. Reproducibility and Applicability of a Pediatric Score of Clinical Deterioration Warning. Rev Min Enferm, 2019; 23: 1-6. DOI: https://doi.org/10.5935/1415-2762.20190003
21. Conselho Regional de Enfermagem de São Paulo. Câmara técnica. Competência para aplicação e avaliação de escalas, escores e índices pediátricos na equipe de enfermagem. Parecer Coren-SP Nº 009/2021. Available from: https://portal.coren-sp.gov.br/wp-content/uploads/2021/04/Parecer_009_2021_Competencia-aplicacao-avaliacao-de-escalas-escores-indices-pediatricos.pdf
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2024-11-20
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Acurácia de dois escores pediátricos de alerta precoce de deterioração clínica no contexto brasileiro. (2024). Ciência, Cuidado E Saúde, 23. https://doi.org/10.4025/ciencuidsaude.v23i0.69249
