Performance of a Pediatric Early Warning Score Among Children With Severe Acute Malnutrition

OBJECTIVES: Pediatric Early Warning Systems (PEWSs) have been used to predict adverse outcomes among hospitalized patients, though evidence is limited in resource-limited settings. We aimed to assess the performance of a novel PEWS score in a population of children with complicated severe acute malnutrition (SAM). METHODS: Children hospitalized with SAM in Madarounfa, Niger were followed longitudinally from hospital admission to discharge. A novel Médecins Sans Frontières (MSF)-PEWS used scores for 9 clinical indicators, summarized into color categories (in increasing order of severity: green, orange, yellow, red) and assessed regularly throughout hospitalization. We estimated the association of color category at admission with subsequent clinical deterioration and mortality, as well as the association between time-varying color category with mortality within 48 hours and time to discharge or death. RESULTS: In total, 4215 children were included in the analysis. Children in the red MSF-PEWS color category at admission had 2.58 (95% CI, 1.87-3.55) times greater risk of death during treatment compared with children in the green category at admission. In time-varying analyses, children classified in the red category at any given time were 11.9 (95% CI, 11.3-12.6) times more likely to die in the following 48 hours than children in the green category. More severe color categories were associated with longer lengths of hospital stay and shorter times until death. CONCLUSIONS: MSF-PEWS scores were effective at identifying children at higher risk of adverse clinical outcomes, including mortality, during inpatient treatment for complicated SAM in Niger.