Abstract
Pediatric Early Warning Systems (PEWS) aim to identify hospitalized children at increased risk of deterioration by assigning a score based on vital signs and clinical status and guiding interventions using a response algorithm to improve outcomes. When implemented with quality improvement methodology, these systems have been shown to be effective in high-resource settings and have the potential to improve the care of children in humanitarian and resource-limited settings (RLS). The purpose of this review is to summarize the current evidence for use of PEWS in RLS and identify areas for further research. A review of the current PEWS literature in RLS was performed using Web of Science, PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), EMBASE, Portal Regional da BVS, and TRIP Database. While there is limited research available on this topic, eight studies on the use of PEWS, or a PEWS score in a pediatric population in low- or middle-income countries were identified. Two studies assessed the clinical effect of implementation of PEWS; one reported a reduction in clinical deterioration events and the other a reduction in mortality. The remaining studies assessed the association of a PEWS score with signs of clinical deterioration or mortality without a response algorithm. Further research on the impact of PEWS implementation on inpatient care and outcomes in RLS is needed.
Highlights
A variety of Pediatric Early Warning Systems (PEWS) have been proposed by multiple groups working in hospitals worldwide [1,2,3,4]
Articles were included for review if they were written in English or Spanish and studied implementation of PEWS or use of a PEWS score in a pediatric population within a resource-limited settings (RLS)
For the purposes of this review studies were considered from RLS if they self-identified as RLS or were conducted in an low- and middleincome countries (LMICs)
Summary
A variety of Pediatric Early Warning Systems (PEWS) have been proposed by multiple groups working in hospitals worldwide [1,2,3,4]. The system consists of two components; the scoring tool, which is calculated at regular intervals during hospital admission and a response algorithm with interventions and/or provider assessments triggered based on the PEWS score. Multiple studies have retrospectively or prospectively validated PEWS in high-resource settings, with Area Under the Receiver Operating Characteristic curve (AUROC) of different scoring systems ranging from 0.73 to 0.91 [1, 3, 8,9,10]. While the reliability and validity of PEWS has been demonstrated, there is conflicting evidence that the use of PEWS impacts patient outcomes such as frequency of cardiac or respiratory arrest or hospital mortality in high-resource settings [11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
