Large collaborative team effort across 3 nations. Huge thanks to all including
@gerri-sefton.bksy.social
@profberniecarter.bsky.social
@ejlim.bsky.social and others not on bsky.

8/Standardisation of PEWS creates a “common language” across different settings and aids benchmarking of prac­tice. This study supports the widespread roll out of proposed National PEWS for England. Further validation is required in other settings.

7/ National standardised PEWS would allow collation of big data across primary to tertiary units to develop evidence-based thresholds for children admit­ted to hospital, modelling for weighting of PEWS com­ponents and the opportunity for periodic recalibration of age-specific risk models.

6/CDE is a more appropriate outcome measure than hospital mortality, due to low mortality in children outside PICU. Our study makes a strong case for the standardisation using the National PEWS for England

5/This is the first study to compare the predictive perfor­mance of various PEWS used in the UK and Ireland for identifying CDEs in hospitalised children. PEWS predictive per­formance remained very good within sub-groups such as those with cyanotic congenital heart disease or chronic hypoxia.

4/We used pre-intervention data from the DETECT study and matched 250 cases with 500 age matched controls (also matched by LOS and month of hospital admission). AUCs across all seven PEWS in predicting CDE, ranged from 0·87 to 0·95 in a heterogenous cohort.

3/The primary outcome was occurrence of a critical deterioration event (CDE) and secondary outcome 72-hour hospital mortality. CDE is defined by patients requiring unplanned admission to critical care (HDU or PICU) and initiation of organ support within the subsequent 12 hours

2/ The aim of this study was to compare the performance of seven PEWS (Alder Hey, Bedside, Bristol, Irish, Newcastle, Scottish and the proposed National PEWS for England) utilised in clinical practice in the United Kingdom and Ireland.

This was a long and challenging project but, at the end, we’ve really contributed to practice. Thank you for your leadership @carrolenitan.bsky.social! Thank you to all the team and participants.

 
16/ Huge thanks to all the team including @emmatj.bsky.social, @ceumateus.bsky.social @cawaldrom.bsky.social @kerryhood.bsky.social @saulfaust.bsky.social @jpreso.bsky.social and others not on here. Funded by @nihr.bsky.social

15/ Our results suggest that in hospitalised children treated with IV antibiotics for suspected/confirmed serious bacterial infection, a procalcitonin-guided algorithm is not effective in reducing IV antibiotic duration, especially where robust AMS programmes are already implemented

14/ The BATCH trial intervention was a PCT-guided algorithm in addition to clinical response +/-CRP. The algorithm advice was strongly suggest stop antibiotics if PCT<0.25, or consider oral switch or stop antibiotics if PCT</=0.5 OR decreased by >/=80% and PCT between 0.5-1.

13/ How does this compare with the recently published ADAPT-sepsis trial? @AdaptSepsis in @jama.com. Children are different from adults. Daily PCT testing outside ICU would not be acceptable in children. ICU more conducive to protocol adherence compared to ward settings.

11/ Pragmatic designs allow real-world evaluation of clinical effectiveness, but not implementation processes, which would allow scale-up of the intervention if found to be effective. i.e. is the intervention generalisable? We need more effectiveness-implementation hybrid designs.

10/ Fourthly, and perhaps most importantly, consider the context. Most of the participants (83%) were recruited from sites with robust antimicrobial stewardship (AMS) programmes. PCT guided algorithms add little value where median duration of IV antibiotics is 100 hrs (4 days).