Assessing children who are acutely ill in general practice using the National PEWS and LqSOFA clinical scores: a retrospective cohort study

Background
Clinical tools are needed in general practice to help identify seriously ill children. The Liverpool
quick Sequential Organ Failure Assessment (LqSOFA) was validated in an Emergency
Department and performed well. The National Paediatric Early Warning score (PEWS) has been
introduced in hospitals throughout England with hopes for implementation in general practice.

Aim
To validate the LqSOFA and National PEWS in general practice.

Design/Setting
Secondary analysis of 6,703 children <5 years presenting to 225 general practices in England and Wales with acute illnesses, linked to hospital data.

Method
Variables from the LqSOFA and National PEWS were mapped onto study data to calculate
score totals. A primary outcome of admission within two days of GP consultation was used to
calculate sensitivity, specificity, negative predictive values (NPV), positive predictive values
(PPV) and area-under-the-curve (AUC).

Results
104/6,703 children were hospitalised within two days (pre-test probability 1.6%). The sensitivity
of the LqSOFA was 30.6% (95% confidence interval 21.8% - 41.0%), with a specificity of 84.7%
(83.7% - 85.6%), PPV of 3.0% (2.1% – 4.4%), NPV of 98.7% (98.4% - 99.0%), and AUC of 0.58
(0.53 - 0.63). The sensitivity of the National PEWS was 81.0% (71.0% - 88.1%), with a specificity
of 32.5% (31.2% - 33.8%); PPV of 1.9% (1.5% - 2.5%); NPV of 99.1% (98.4% - 99.4%) and
AUC of 0.66 (0.59 - 0.72).

Conclusion
Although the NPVs appear useful, due to low pre-test probabilities rather than discriminative
ability, neither tool accurately identified hospitalisations. Unconsidered use by GPs could result
in unsustainable referrals.