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
- 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**|
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.
Original/Primary ReferenceMonaghan A. Detecting and managing deterioration in children. Paediatr Nurs. 2005;17:32–5.
ValidationAkre M, Finkelstein M, Erickson M, Liu M, Vanderbilt L, Billman G. Sensitivity of the pediatric early warning score to identify patient deterioration .Pediatrics 2010 Apr;125(4):e763-9. doi: 10.1542/peds.2009-0338. Epub 2010 Mar 22.Seiger N, Maconochie I, Oostenbrink R, Moll HA. Validity of different pediatric early warning scores in the emergency department. Pediatrics. 2013 Oct;132(4):e841-50. doi: 10.1542/peds.2012-3594. Epub 2013 Sep 9.Duncan H, Hutchison J, Parshuram CS. The Pediatric Early Warning System score: a severity of illness score to predict urgent medical need in hospitalized children. J Crit Care. 2006 Sep;21(3):271-8.
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