Katie Nielsen, MD, MPH
Nominated From: University of Washington
Research Site: Peru
Project: Pediatric critical care
Primary Mentor: Joan Roberts
Research Project Background
Peru has strikingly poor health indicators, with infant and under 5 mortality rates of 15 and 19 per 1000 live births, respectively, which are 2-3 times those in the United States (1). A significant portion of these deaths occur within the hospital, and data from other countries suggest hospitalized patients show signs of clinical deterioration prior to cardiac or respiratory arrest in the majority of cases (2). To identify patients at risk of deterioration, hospitals have developed early warning scores that assign points for abnormal vital signs and clinical assessment. Implementation of these scores has decreased in-hospital pediatric and adult mortality (3-4).
Recently, these scores have been used in the emergency department (ED) to improve early identification of critically ill patients and timely transfer to higher levels of care; however, this use has not yet been well established (5). My fellowship research project at Seattle Children’s Hospital (SCH) focuses on ED risk factors associated with transfer from the inpatient ward to the pediatric intensive care unit (PICU) within 24 hours of admission. Preliminary data suggest a higher modified pediatric early warning score (MPEWS) in the ED increases an inpatient’s risk of PICU transfer (data not published). Therefore, using MPEWS in the ED to directly assign at-risk patients to the PICU may improve overall patient outcomes, just as implementation of sepsis and stroke guidelines of care has improved timely initiation of therapy, and subsequently patient outcomes for these conditions.
In this study, we propose that implementation of MPEWS within Peruvian EDs will reduce pediatric inpatient mortality. The two potential sites are the Instituto Nacional de Salud del Niño (INSN), the major pediatric reference hospital in Peru, with over 50,000 ED visits and 10,000 admissions in 2011 (6), and Hospital Nacional Edgardo Rebagliati Martins (Rebagliati), a major referral hospital with most adult and pediatric subspecialties, including a PICU.
Meet Dr. Nielsen