Figure 13.1 Paediatric early warning scores are a systematic tool designed to detect early deterioration in children
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Paediatric Early Warning Score
Paediatric Early Warning Score (PEWS) is a systematic clinical tool used to facilitate and detect the signs of clinical deterioration in the patient. Initially, early warning systems were devised as a method of early identification and prediction of which children are likely to deteriorate and necessitate high dependency or intensive care, as it is known that children who die or require intensive care have exhibited signs of deterioration prior to collapse. They are now an integral part of the care of the majority of acutely ill children in hospital. They may have some use as a triage tool in the A&E department. PEWS is a risk management tool and may also be referred to as ‘track and trigger’.
Calculating the Paediatric Early Warning Score
The score is calculated by adding the numerical values together that have been assigned to the routine observations that are undertaken on infants and children. Once the score is calculated, the nursing and/or medical staff refer to the algorithm on the chart which will indicate the action required. This multiparameter scoring system includes routine observations: heart rate, respiratory rate, blood pressure, oxygen saturation level, temperature and conscious level. Other observations and treatments may also be considered such as oxygen therapy. Each parameter is allocated a score, which are then added together to give an overall score. The greater the deviation from normal for the physical sign being measured, the higher the score. Generally, if the child’s clinical condition is deteriorating the score is high, thus alerting the nursing and medical team that early intervention is required early in anticipation of preventing adverse outcomes. Early intervention may prevent the need for transferring the child to a higher level of care. Early intervention may indicate the need for more frequent observation of the child and a revision of his/her treatment plan.
PEWS provides nursing and medical staff with a framework to escalate their concerns about a child to a more senior team member.
Education on how to use the PEWS tool effectively should be considered.
Limitations
There is currently limited research into the trigger points for scoring and escalating concerns. Inconsistency in the use of PEWS and scoring make is difficult to validate its effectiveness.
There are a variety of scoring systems in existence but with limited methodological assessment to identify their reliability or validity.
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