How does this pediatric early warning score (PEWS) calculator work?
This is a health tool that aims to be the adaptation of the national early warning score for infants and children. It is a very straight forward and quick to use questionnaire to be filled in during the ER assessment and during subsequent pediatric evaluations. The criteria observed are described below:
1) Behavior – examines the appearance and actions of the child, similar to criteria used in AVPU evaluations:
■ Playing or sleeping comfortably (0 points);
■ Irritable and consolable (1 point);
■ Irritable and NOT consolable (2 points);
■ Lethargic, confused or reduced response to pain (3 points).
2) Cardiovascular – observes teguments and capillary refill time as well as pulse:
■ Pink or capillary refill time
■ Pale or capillary refill time 3 seconds (1 point);
■ Grey or capillary refill time 4 seconds (2 points);
■ Heart rate 20 above or below normal rate (2 points);
■ Grey and mottled or capillary refill time >4 seconds (3 points);
■ Heart rate 30 above or below normal heart rate (3 points).
3) Respiratory – evaluates saturation in oxygen and breathing rate:
■ Within normal rate, no retractions and S pO2 98-100% on RA (0 points);
■ RR >10 above normal limits or S pO2 98-100% on any O2 device (1 point);
■ S pO2 94-97% on RA OR using accessory muscles (1 point);
■ RR>20 above normal limits or S pO2 90-93% or retractions (2 points);
■ RR 5 or below normal or S pO2 <90% or retractions and grunting (3 points).
4) Output:
■ Reaching target urine output goal of 0.5-1mL/kg/h and 0-1 BMs/emesis events in the last 12h (0 points);
■ 2 BMs/emesis events in the last 12h (1 point);
■ 3 BMs/emesis events in the last 12h (2 points);
■ 3 BMs/emesis in the last 12h (3 points).
This pediatric early warning score (PEWS) calculator can be used to assess respiratory distress in children with pneumonia presentation and although similar in method with the pediatric GCS the main target is to stratify risk in order to ensure patients are viewed in the order of gravity. There are several studies trying to validate the model available and most of them have shown it has a high sensitivity in identifying patient deterioration.
PEWS interpretation
This score is used predominantly to increase the efficiency of emergency room response and to stratify pediatric patient risk, similar to what the modified early warning score, MEWS does in the case of adult patients.
The answers chosen in each of the four items of the score are awarded a number of points as presented below. The overall score comprises of their sum (from 0 to 12) and the results are divided in risk categories:
■ Code green: (0-3). This result indicates that no action is immediately required but the patient should continue to be monitored and the status reassessed accordingly.
* In case the overall score is 3 AND any of the 4 criteria is awarded with 3 points this explanation is added to the result being displayed:
Although the result belongs to the code green range, when there is one preliminary score of 3 in the answers chosen, the specific hierarchical medical professional needs to be notified and to evaluate the patient right away.
■ Code amber: (4-6). This result indicates that the specific hierarchical medical professional should be notified and that the patient should be seen by them as soon as possible.
■ Code red: (7-12). This result indicates that the specific hierarchical medical professional should be notified and that the patient should be seen by them as a matter of urgency immediately.
Another version of interpretation consists in the guidelines for reassessment according to the PEWS score:
■ Scores less than 4 – it is recommended to be assessed every 4 hours;
■ Scores of 5 – assessment every 1-2 hours;
■ Scores of 6 – require hourly evaluation;
■ Scores of 7 to 12 – indicate half hourly evaluation.
References
1) Gold DL, Mihalov LK, Cohen DM. (2014) Evaluating the Pediatric Early Warning Score (PEWS) System for Admitted Patients in the Pediatric Emergency Department. Acad Emerg Med; 21(11): 1249–1256.
2) Duncan H, Hutchison J, Parshuram CS. (2006) The Pediatric Early Warning System score: a severity of illness score to predict urgent medical need in hospitalized children. J Crit Care; 21(3):271-8.
3) Roland D. (2013) Republished: Paediatric early warning scores: Holy Grail and Achilles' heel. Postgrad Med J;89:358-365.
18 Nov, 2015
