Predicting Intensive Care Transfers and Unforeseen Events in Pediatric Inpatients (PICTURE-Peds)
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Quality and Patient Safety, Pediatrics, 2022
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INTRODUCTION: Early detection of clinical instability and use of rapid response teams (RRTs) have been shown to reduce pediatric hospital mortality. Integral to these systems are pediatric specific early warning scores such as PEWS and PAWS, yet multiple studies have reported inadequate RRT activation in some deteriorating patients. Automated data collection and machine learning analytics could improve our ability to identify at-risk patients. PICTURE-Peds utilizes these tools for early identification of patient decompensation. We hypothesize that PICTURE-Peds will outperform PEWS, PAWS, and pediatric SIRS in identifying patients requiring ICU transfer. METHODS: PICTURE-Peds was developed utilizing 10,364 encounters from 2014-2018. Using outcomes of ICU transfer or death within 24 hrs, an XGBoost model with 30 round early stopping criterion was trained using vital signs, labs, and demographics from retrospective data (80% to train the model; 20% for validation). The model was then applied to a test set of 2,858 encounters from 2019. Inclusion criteria were general care patients 1 mo to 18 yrs with a CBC and/or BMP. AUROC and AUPRC for PICTURE-Peds were compared to bedside PEWS, PAWS, and pediatric SIRS. The comparison was made at an observational level, evaluating alarms separately, and at an encounter level, evaluating the maximum score for a patient during an admission. RESULTS: On the observation level, AUROC for PICTURE was 0.85 (95% CI 0.82–0.87) vs PAWS: 0.81 (0.78–0.84), PEWS: 0.77 (0.75–0.80) and SIRS: 0.53 (0.50–0.57). The AUPRC (observation) for PICTUE was 0.15 (0.11–0.19) vs PAWS: 0.12 (0.08–0.14), PEWS: 0.09 (0.06–0.11) and SIRS: 0.04 (0.02–0.04). At the encounter level AUROC for PICTURE was 0.85 (0.81–0.89) vs PAWS: 0.75 (0.72–0.79), PEWS: 0.66 (0.62–0.70) and SIRS: 0.49 (0.46–0.53). The AUPRC (encounter) for PICTURE was 0.43 (0.37–0.47) vs PAWS: 0.28 (0.23–0.32), PEWS: 0.20 (0.16–0.23) and SIRS: 0.10 (0.08–0.12). P < 0.001 comparing PICTURE to all others except observational AUPRC vs. PAWS (p=0.028). CONCLUSION: PICTURE-Peds outperformed traditional scoring systems in identifying patients requiring ICU transfer. This innovative early warning system may also allow for predictive analytics of patient deterioration and is being studied prospectively, deployed within the EMR at Mott Children’s Hospital.
Meta Tag
Content Type Presentation
Knowledge Area Quality and Patient Safety
Knowledge Area Pediatrics
Knowledge Level Advanced
Membership Level Select
Tag Scoring Systems
Tag Pediatrics
Year 2022
PICTURE Pediatrics
machine learning algorithm
patient deterioration
electronic medical records


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