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    Pediatric Early Warning Score (PEWS)

    Identifies pediatric patients at risk for clinical deterioration.
    When to Use
    Why Use

    Pediatric inpatients.

    • Originally developed to provide a practical and objective method to identify pediatric inpatients at risk for cardiac arrest.
    • Can be used by staff and providers at all levels to escalate care for sick patients.

    Provides an objective measurement for patients who “look sick.”

    Lethargic/confused or reduced response to pain
    Pink OR capillary refill 1–2 seconds
    Pale OR capillary refill 3 seconds
    Gray OR capillary refill 4 seconds OR tachycardia of 20 bpm above normal
    Gray and mottled OR capillary refill ≥5 seconds OR tachycardia of 30 bpm above normal OR bradycardia
    Within normal parameters, no retractions
    >10 above normal parameters using accessory muscles OR 30+ %FiO2 or 3+ L/min
    >20 above normal parameters and retractions OR 40+ %FiO2 or 6+ L/min
    Five below normal parameters with retractions and grunting OR 50% FiO2 or 8+ L/min


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    Next Steps
    Creator Insights


    Consider escalation of care in patients with high (≥3) PEWS, including escalating to senior staff, increasing frequency of vital signs measurements and clinical assessments, and/or consultation to an intensive care unit.


    Addition of assigned points.

    Facts & Figures

    Score interpretation:

    • PEWS ≤2: low risk
      • Reassess as needed
    • PEWS 3-4: intermediate risk
      • Recommended to alert charge nurse and staff MD
    • PEWS ≥5: high risk
      • Recommended to initiate rapid response team

    Normal parameters as per University of Maryland:

    Age Awake Heart Rate (bpm) Sleeping Heart Rate (bpm) Respiratory Rate at rest (breaths/min) Systolic Blood Pressure Diastolic Blood Pressure Systolic Hypotension
    Newborn ≤1 month 100-205 90-160 40-60 67-84 35-53 <60
    Infant (1-12 months) 100-180 90-160 30-53 72-104 37-56 <70
    Toddler (13 months - 3 years) 98-140 80-120 22-37 86-106 42-63 <70 + (2x Age in years)*
    Preschool (4-6 years) 80-120 65-100 20-28 89-112 47-72
    School Age (7-12 years) 75-118 58-90 18-26 97-120 57-80
    Adolescent (13-19 years) 60-100 50-90 12-20 110-131 64-83 <90**

    Evidence Appraisal

    The Pediatric Early Warning Score (PEWS) was developed by expert consensus by a multidisciplinary group at Brighton and Sussex University Hospitals NHS Trust in the UK in order for nurses and junior medical staff to identify pediatric patients at risk for clinical deterioration.

    Triggers were identified by polling a multidisciplinary group at all levels of patient care on what clinical features they considered concerning, including both appearance and vital signs. The criteria were revised based on a pilot that identified patients who deteriorated who were not identified by the original score.

    Several studies have validated the PEWS, including one by Duncan et al which found an area under the receiver operating characteristic curve of 0.90, with 78% sensitivity and 95% specificity at a score of 5.


    Mr. Alan Monaghan

    About the Creator

    Alan Monaghan, MSc, is a senior lecturer at the University of Brighton in the United Kingdom. His current research focuses on implementation of pediatric early warning scores in the community setting and has completed research on pediatric critical care nursing.

    To view Mr. Alan Monaghan's publications, visit PubMed

    About the Creator
    Mr. Alan Monaghan
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