Aplicação da nota de transferência e do Paediatric Early Warning Score no serviço de emergência pediátrica do Hospital de Clínicas de Porto Alegre

Objetivo: avaliar a adesão dos enfermeiros ao preenchimento da Nota de Transferência com emissão do Paediatric Early Warning Score (PEWS) em pacientes pediátricos do Serviço de Emergência.Método: estudo quantitativo, transversal e retrospectivo. O estudo foi realizado a partir da análise de 1.219 prontuários de pacientes de uma unidade de emergência pediátrica, no ano de 2018.Resultados: na avaliação da nota de transferência e PEWS, houve adesão de, respectivamente, 86,8% e 75,2% ao longo do ano. Os motivos de hospitalização variam conforme época do ano. Os pacientes atendidos no Serviço de Emergência foram, majoritariamente, estabilizados no serviço e, somente os pacientes com PEWS alterado, foram encaminhados à unidade de terapia intensiva pediátrica.Conclusões: são necessárias ações de educação com os profissionais, com a finalidade de melhoria dos indicadores relacionados à aplicação do PEWS e da nota de transferência para a garantia de uma assistência segura no que tange à continuidade do cuidado.

Changes in paediatric respiratory infections at a UK teaching hospital 2016-2021; impact of the SARS-CoV-2 pandemic.

Objective To describe the impact of the SARS-CoV-2 pandemic on the incidence of paediatric viral respiratory tract infection in Oxfordshire, UK. Methods Data on paediatric Emergency Department (ED) attendances (0-15 years inclusive), respiratory virus testing, vital signs and mortality at Oxford University Hospitals were summarised using descriptive statistics. Results Between 1-March-2016 and 30-July-2021, 155,056 ED attendances occurred and 7,195 respiratory virus PCRs were performed. Detection of all pathogens was suppressed during the first national lockdown. Rhinovirus and adenovirus rates increased when schools reopened September-December 2020, then fell, before rising in March-May 2021. The usual winter RSV peak did not occur in 2020/21, with an inter-seasonal rise (32/1,000 attendances in 0-3yr olds) in July 2021. Influenza remained suppressed throughout. A higher Paediatric Early Warning Score (PEWS) was seen for attendees with adenovirus during the pandemic compared to pre-pandemic (p=0.04, Mann-Witney U test), no other differences in PEWS were seen. Conclusions SARS-CoV-2 caused major changes in the incidence of paediatric respiratory viral infection in Oxfordshire, with implications for clinical service demand, testing strategies, timing of palivizumab RSV prophylaxis, and highlighting the need to understand which public health interventions are most effective for preventing respiratory virus infections.

Inter-rater reliability of two paediatric early warning score tools

Background: Paediatric early warning score (PEWS) assessment tools can assist healthcare providers in the timely detection and recognition of subtle patient condition changes signalling clinical deterioration. However, PEWS tools instrument data are only as reliable and accurate as the caregivers who obtain and document the parameters. The aim of this study is to evaluate inter-rater reliability among nurses using PEWS systems. Method: The study was carried out in five paediatrics departments in the Central Denmark Region. Inter-rater reliability was investigated through parallel observations. A total of 108 children and 69 nurses participated. Two nurses simultaneously performed a PEWS assessment on the same patient. Before the assessment, the two participating nurses drew lots to decide who would be the active observer. Intraclass correlation coefficient, Fleiss’ κand Bland–Altman limits of agreement were used to determine inter-rater reliability. Results: The intraclass correlation coefficients for the aggregated PEWS score of the two PEWS models were 0.98 and 0.95, respectively. The κvalue on the individual PEWS measurements ranged from 0.70 to 1.0, indicating good to very good agreement. The nurses assigned the exact same aggregated score for both PEWS models in 76% of the cases. In 98% of the PEWS assessments, the aggregated PEWS scores assigned by the nurses were equal to or below 1 point in both models. Conclusion: The study showed good to very good interrater reliability in the two PEWS models used in the Central Denmark Region.