# Pediatric early warning score and unplanned readmission with influenza at emergency observation room

## TL;DR

This study shows that higher pediatric early warning scores (PEWS) are linked to a greater risk of children with influenza being readmitted to the emergency observation room within 72 hours.

## Contribution

The study demonstrates the potential of PEWS as a predictive tool for unplanned readmissions in children with influenza.

## Key findings

- Each 1-point increase in PEWS significantly raises the risk of unplanned readmission.
- Non-readmitted patients were more likely to take oseltamivir than those readmitted.
- A PEWS cutoff of 3 showed high sensitivity and specificity for predicting readmission.

## Abstract

This study explored the predictive value of the pediatric early warning scores (PEWS) in recognizing clinical deterioration and identifying children with influenza with unplanned readmission to the emergency observation room (EOR) within 72 h.

A total of 196 children were included in this single-center case–control study conducted between 1 January and 30 June 2024. PEWS scores and receiver operating characteristic curves were used to evaluate the correlations between the scores and the likelihood of influenza necessitating readmission.

For each 1-point increase in PEWS score, the risk of unplanned readmission significantly increased with unadjusted PEWS of [OR 9.98 (1.54–64.73); P = 0.016] and adjusted PEWS of [OR 10.53 (3.47–31.98); P < 0.001], respectively. The time to reach the highest PEWS was significantly longer in patients who experienced unplanned readmissions (P < 0.01). Among the non-readmitted patients, 100 out of 147 (68.03%) took oseltamivir orally, compared with only 10 out of 49 (20.41%) patients with unplanned readmissions within 72 h (P < 0.001). A PEWS cutoff score of 3 indicated a relatively high sensitivity of 61.2% and specificity of 96.6%, with a positive likelihood ratio (PLR) of 18.0 and a negative likelihood ratio of 0.4.

PEWS is potential for predicting unplanned readmissions with similar symptoms in children with influenza, demonstrating it may be an essential tool for enhancing patient care and outcomes.