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

Clark, A ORCID: 0000-0002-9409-0486, Cannings-John, R ORCID: 0000-0001-5235-6517, Carrol, ED ORCID: 0000-0001-8357-7726, Thomas-Jones, E ORCID: 0000-0001-7716-2786, Sefton, G ORCID: 0000-0003-4159-6341, Hay, AD ORCID: 0000-0003-3012-375X, Butler, CC ORCID: 0000-0002-0102-3453 and Hughes, K ORCID: 0000-0002-8099-066X (2025) Assessing children who are acutely ill in general practice using the National PEWS and LqSOFA clinical scores: a retrospective cohort study British Journal of General Practice, 75 (751). e98-e104. ISSN 0960-1643, 1478-5242

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Abstract

Background Clinical tools are needed in general practice to help identify children who are seriously ill. The Liverpool quick Sequential Organ Failure Assessment (LqSOFA) was validated in an emergency department and performed well. The National Paediatric Early Warning System (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 and setting Secondary analysis of 6703 children aged <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 2 days of GP consultation was used to calculate sensitivity, specificity, negative predictive values (NPVs), positive predictive values (PPVs), and area under the receiver operating characteristic curve (AUC). Results A total of 104/6703 children were admitted to hospital within 2 days (pre-test probability 1.6%) of GP consultation. The sensitivity of the LqSOFA was 30.6% (95% confidence interval [CI] = 21.8% to 41.0%), with a specificity of 84.7% (95% CI = 83.7% to 85.6%), PPV of 3.0% (95% CI = 2.1% to 4.4%), NPV of 98.7% (95% CI = 98.4% to 99.0%), and AUC of 0.58 (95% CI = 0.53 to 0.63). The sensitivity of the National PEWS was 81.0% (95% CI = 71.0% to 88.1%), with a specificity of 32.5% (95% CI = 31.2% to 33.8%), PPV of 1.9% (95% CI = 1.5% to 2.5%), NPV of 99.1% (95% CI = 98.4% to 99.4%), and AUC of 0.66 (95% CI = 0.59 to 0.72). Conclusion Although the NPVs appear useful, owing to low pre-test probabilities rather than discriminative ability, neither tool accurately identified admissions to hospital. Unconsidered use by GPs could result in unsustainable referrals.

Item Type:	Article
Uncontrolled Keywords:	child health, clinical prediction rule, early warning score, general practice, retrospective studies, triage
Divisions:	Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Infection, Vet & Ecological Sciences
Depositing User:	Symplectic Admin
Date Deposited:	18 Dec 2024 15:26
Last Modified:	28 Feb 2026 20:49
DOI:	10.3399/BJGP.2023.0638
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3189289
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