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Pediatric Early Warning Score (PEWS)
Identifies pediatric patients at risk for clinical deterioration.
When to Use
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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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:
Awake Heart Rate (bpm)
Sleeping Heart Rate (bpm)
Respiratory Rate at rest (breaths/min)
Systolic Blood Pressure
Diastolic Blood Pressure
Newborn ≤1 month
Infant (1-12 months)
Toddler (13 months - 3 years)
<70 + (2x Age in years)*
Preschool (4-6 years)
School Age (7-12 years)
Adolescent (13-19 years)
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.
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