Implementation of the Paediatric Early Warning Score in the Observation Room of the Emergency Department of a Second Level Hospital

The Paediatric Early Warning Score (PEWS) was initially developed to pre-emptively identify hospitalized children who were at risk of clinical deterioration^1,2. A study in a paediatric Emergency Department (ED) found that an elevated score was associated with need for Intensive Care Unit (ICU) admission³. A lot of PEWS systems have been developed but a recent systematic review noticed lack of consensus on which PEWS is most effective, although improved clinical outcomes were reported⁴. In July 2017 we implemented the Irish PEWS⁵ in our paediatric ED aiming to objectify and improve clinical monitoring in our unit.

The purpose of this study is to review our data by verifying if a higher PEWS score correlated to clinical deterioration and if it is applicable to our clinical practice.

To do so we evaluated medical records of patients who were applied the PEWS between July 2017 and March 2019 and registered the maximum score (MS). We defined clinical deterioration as the need for ICU transfer, higher respiratory support or the presence of sepsis criteria.

We evaluated 840 children admitted to the ED observation room, whose age and MS distributions are represented, respectively by the graphics 1 and 2. The MS was ≥4 in 181 (22%). For a MS ≥4, the sensibility and specificity for clinical deterioration was respectively 96.5% and 84.0%. Respiratory diseases were the most common diagnosis (227 patients), with 135 (59%) MS ≥4, whose sensibility and specificity for clinical deterioration were, respectively, 100% and 48.9%. We also evaluated this score for MS of 5 and 6.

In addition of being a system that allows a standardized surveillance, the use of this score seems to improve patient safety and medical decision, particularly by excluding clinical deterioration, as showed by the high sensitivity values ​​reached using the MS of 4 as a cut-off.