Development and initial validation of the Bedside Paediatric Early Warning System score

Abstract

Introduction: Adverse outcomes following clinical deterioration in children admitted to hospital wards is frequently preventable. Identification of children for referral to critical care experts remains problematic. Our objective was to develop and validate a simple bedside score to quantify severity of illness in hospitalized children.

Methods: A case-control design was used to evaluate 11 candidate items and identify a pragmatic score for routine bedside use. Case-patients were urgently admitted to the intensive care unit (ICU). Control-patients had no 'code blue', ICU admission or care restrictions. Validation was performed using two prospectively collected datasets.

Results: Data from 60 case and 120 control-patients was obtained. Four out of eleven candidate-items were removed. The seven-item Bedside Paediatric Early Warning System (PEWS) score ranges from 0-26. The mean maximum scores were 10.1 in case-patients and 3.4 in control-patients. The area under the receiver operating characteristics curve was 0.91, compared with 0.84 for the retrospective nurse-rating of patient risk for near or actual cardiopulmonary arrest. At a score of 8 the sensitivity and specificity were 82% and 93%, respectively. The score increased over 24 hours preceding urgent paediatric intensive care unit (PICU) admission (P < 0.0001). In 436 urgent consultations, the Bedside PEWS score was higher in patients admitted to the ICU than patients who were not admitted (P < 0.0001).

Conclusions: We developed and performed the initial validation of the Bedside PEWS score. This 7-item score can quantify severity of illness in hospitalized children and identify critically ill children with at least one hours notice. Prospective validation in other populations is required before clinical application.

Figure 1

The receiver operating characteristics curve for the maximum Bedside Paediatric Early Warning System score. Results are shown for the 11 hours ending one hour before urgent ICU admission and for 12 hours in control patients who had not clinical deterioration event. The area under the receiver operating characteristics curve was 0.91 with sensitivity 82% and specificity 93% at a threshold score of 8.

Figure 2

Progression of Bedside PEWS score with increasing proximity to urgent paediatric ICU admission. We present the mean of the maximum Bedside Paediatric Early Warning System (PEWS) score and standard error of the mean for time periods 0–3, 4–7, 8–11, 12–15, 16–19 and 20–24 hours before intensive care unit (ICU) admission.