Pediatric Early Warning Score Scores Research Articles

Comparison of bedside risk assessment scores to predict the outcome of patients with acute febrile illness admitted to pediatric intensive care unit: A single-center prospective observational study

Abstract Background: Acute febrile illness (AFI) is the most common presentation in the pediatric emergency room, and bedside risk assessment scores are very useful to identify those at risk. This study aimed to evaluate the predictive validity of quick Sequential Organ Failure Assessment (qSOFA), quick Pediatric Logistic Organ Dysfunction-2 (qPELOD-2), Liverpool qSOFA (LqSOFA), and Pediatric Early Warning Score (PEWS) to predict the outcome of patients with AFI admitted to the pediatric intensive care unit (PICU). Subjects and Methods: This prospective observational study included children under the age of 18 years admitted to PICU. A thorough history and examination was performed in the ER, and the qSOFA, the qPELOD-2, the LqSOFA, and the PEWS scores were calculated. The primary outcome was inhospital mortality. The capacity of the scores to predict outcome was evaluated for calibration (using Hosmer–Lemeshow adaptation of the Chi-square test) and discrimination (using receiver operating characteristic [ROC] curve). The scores were compared for any significant difference using z-statistics. Results: The study included 239 patients with the most common diagnosis of dengue fever. The overall mortality rate in the study was 8.4%. On the calibration of the models, all the scores showed a good fit to predict mortality. On discrimination by ROC curve, the LqSOFA score and PEWS had the best area under the curve for ROC curve (AUC-ROC) (0.913), followed by the qSOFA score (0.859). On comparing the AUC-ROC curve, no statistically significant difference was found between the scoring systems to predict mortality. Conclusions: Bedside risk stratification scores are a simple and convenient tool to identify patients at risk for mortality and assess prognosis. No single assessment tool was found superior to others.

Using the Delphi method to establish pediatric emergency triage criteria in a grade A tertiary women’s and children’s hospital in China

BackgroundWe aimed to establish simplified and quantifiable triage criteria in pediatric emergency care, improving the efficiency of pediatric emergency triage and ensuring patient safety.MethodsWe preliminarily determined the pediatric emergency triage criteria with references to pediatric emergency department characteristics and internationally recognized triage tools after literature review and discussion. The final determination of the triage criteria was reached after two rounds of Delphi surveys completed by18 experts from 3 hospitals in China.ResultsBoth round 1 and round 2 surveys had a 100% response rate. The overall expert authority coefficient in the two rounds of surveys was 0.872. The experts had 100% enthusiasm for participating in the surveys. Kendall’s coefficients of concordance for conditions/symptoms in patients triaged to level 1, 2, 3, and 4 were 0.149, 0.193, 0.102, and 0.266, respectively. All p-values were less than 0.05. The coefficients of variation in conditions/symptoms, vital signs, and the Pediatric Early Warning Score (PEWS) ranged between 0.00 and 0.205, meeting the inclusion criteria. The pediatric emergency triage criteria containing conditions/symptoms, vital signs, PEWS scores, and other 4 level 1 indicators, 51 level 2 indicators and 23 level 3 indicators were built. The maximum waiting time to treatment for the patients triaged to level 1, 2, 3, and 4 was immediate, within 10 min, within 30 min, and within 240 min, respectively.ConclusionThe pediatric emergency triage criteria established in this study was scientific and reliable. It can be used to quickly identify the patients requiring urgent and immediate care, thereby ensuring the priorities for the care of critically ill patients.

Accuracy and Monitoring of Pediatric Early Warning Score (PEWS) Scores Prior to Emergent Pediatric Intensive Care Unit (ICU) Transfer: Retrospective Analysis.

BackgroundCurrent approaches to early detection of clinical deterioration in children have relied on intermittent track-and-trigger warning scores such as the Pediatric Early Warning Score (PEWS) that rely on periodic assessment and vital sign entry. There are limited data on the utility of these scores prior to events of decompensation leading to pediatric intensive care unit (PICU) transfer.ObjectiveThe purpose of our study was to determine the accuracy of recorded PEWS scores, assess clinical reasons for transfer, and describe the monitoring practices prior to PICU transfer involving acute decompensation.MethodsWe conducted a retrospective cohort study of patients ≤21 years of age transferred emergently from the acute care pediatric floor to the PICU due to clinical deterioration over an 8-year period. Clinical charts were abstracted to (1) determine the clinical reason for transfer, (2) quantify the frequency of physiological monitoring prior to transfer, and (3) assess the timing and accuracy of the PEWS scores 24 hours prior to transfer.ResultsDuring the 8-year period, 72 children and adolescents had an emergent PICU transfer due to clinical deterioration, most often due to acute respiratory distress. Only 35% (25/72) of the sample was on continuous telemetry or pulse oximetry monitoring prior to the transfer event, and 47% (34/72) had at least one incorrectly documented PEWS score in the 24 hours prior to the event, with a score underreporting the actual severity of illness.ConclusionsThis analysis provides support for the routine assessment of clinical deterioration and advocates for more research focused on the use and utility of continuous cardiorespiratory monitoring for patients at risk for emergent transfer.

Validity of the Pediatric Early Warning Score and the Bedside Pediatric Early Warning Score in Classifying Patients Who Require the Resources of a Higher Level Pediatric Hospital

Introduction: The pediatric early warning score (PEWS) and the bedside pediatric early warning score (BPEWS) are validated tools that help determine the need for critical care in children with acute medical conditions. These tools could be used by EMS and have not been evaluated outside of the hospital. This study retrospectively tested the validity of these tools in the prehospital setting to identify children who needed a hospital with higher level pediatric resources. Methods: This was a multi-center retrospective validation of screening tools using prehospital and in-hospital data obtained from 3 EMS agencies. EMS patient records from April 1, 2013 to April 30, 2015 were used to identify subjects for this analysis. Pediatric patients were retrospectively classified using the PEWS based on the clinical information documented in the EMS medical record. Those with PEWS scores greater than 4 were matched to a subject with scores less than 4 based on age, gender, and paramedic primary impression. Hospital medical record review was then used to determine whether the patient required a hospital with higher level pediatric resources. These classifications were used to calculate sensitivity, specificity, and resultant 95% confidence intervals. The analysis was repeated for included subjects who had sufficient data to calculate BPEWS. Results: There were 386 patients enrolled. A PEWS ≥ 4 demonstrated a sensitivity of 62.8 (95% CI 53.6–71.4) and a specificity of 55.9 (95% CI 49.6–61.9) in identifying a patient who required a hospital with higher level pediatric resources. There were 44 pairs of patients that had sufficient EMS data documented to calculate a BPEWS. A BPEWS ≥ 7 demonstrated a sensitivity of 46.4 (95% CI 27.5–66.1) and a specificity of 76.7 (95% CI 64.0–86.6) to correctly classify a patient who required a hospital with higher level pediatric resources. Conclusion: In the prehospital setting neither PEWS nor BPEWS exhibited sufficient sensitivity for clinical use to accurately identify children who need a hospital with higher level pediatric resources. Further research should be conducted to identify variables that are captured by prehospital care providers and are associated with children who need a hospital with higher level pediatric resources.

Inter-rater reliability of two paediatric early warning score tools

Background: Paediatric early warning score (PEWS) assessment tools can assist healthcare providers in the timely detection and recognition of subtle patient condition changes signalling clinical deterioration. However, PEWS tools instrument data are only as reliable and accurate as the caregivers who obtain and document the parameters. The aim of this study is to evaluate inter-rater reliability among nurses using PEWS systems. 
 Method: The study was carried out in five paediatrics departments in the Central Denmark Region. Inter-rater reliability was investigated through parallel observations.
 A total of 108 children and 69 nurses participated. Two nurses simultaneously performed a PEWS assessment on the same patient. Before the assessment, the two participating nurses drew lots to decide who would be the active observer. Intraclass correlation coefficient, Fleiss’ κand Bland–Altman limits of agreement were used to determine inter-rater reliability.
 Results: The intraclass correlation coefficients for the aggregated PEWS score of the two PEWS models were 0.98 and 0.95, respectively. The κvalue on the individual PEWS measurements ranged from 0.70 to 1.0, indicating good to very good agreement. The nurses assigned the exact same aggregated score for both PEWS models in 76% of the cases. In 98% of the PEWS assessments, the aggregated PEWS scores assigned by the nurses were equal to or below 1 point in both models.
 Conclusion: The study showed good to very good interrater reliability in the two PEWS models used in the Central Denmark Region.

Nested case-control study of multiple serological indexes and Brighton pediatric early warming score in predicting death of children with sepsis.

BACKGROUNDCurrently, it is difficult to predict the complications of children at the early stage of sepsis. Brighton pediatric early warning score (PEWS) is a disease risk assessment system that is simple and easy to operate, which has good sensitivity and specificity in disease recognition among children. Because detection indicators vary widely in children, a single indicator is difficult to assess the post-treatment status of children with sepsis.AIMTo investigate the relationship between serological markers, Brighton PEWS, and death in children with sepsis after treatment.METHODSA total of 205 children diagnosed with sepsis at our hospital were enrolled. The baseline data, serum scores, and PEWS scores were recorded. In the nested case-control study, children who died during the study period were included in an observation group. According to the matching principle, the children who were not dead in the same cohort were included in a control group. The influencing factors of death in children with sepsis after treatment and the value of each evaluation index in predicting the prognosis of children were analyzed.RESULTSA total of 96 children were enrolled in the study, including 48 each in the observation group and the control group. Multivariate logistic regression analysis indicated that antibacterial treatments within 1 h (P = 0.017), shock (P = 0.044), multiple organ dysfunction syndrome (MODS) (P = 0.027), serum procalcitonin (PCT) (P = 0.047), serum albumin (ALB) (P = 0.024), and PEWS (P = 0.012) were independent risk factors for the death of children with sepsis. The area under the curve of the combination of ALB, PCT, and PEWS to predict the death in children with sepsis was the highest (0.908).CONCLUSIONAntibacterial treatments within 1 h, shock, MODS, PCT, ALB, and PEWS are independent risk factors for the death of children with sepsis. The predictive accuracy of the combination of PCT, ALB, and PEWS for the prognosis of children with sepsis is the best.

Inter-rater reliability of two paediatric early warning score tools.

Paediatric early warning score (PEWS) assessment tools can assist healthcare providers in the timely detection and recognition of subtle patient condition changes signalling clinical deterioration. However, PEWS tools instrument data are only as reliable and accurate as the caregivers who obtain and document the parameters. The aim of this study is to evaluate inter-rater reliability among nurses using PEWS systems. The study was carried out in five paediatrics departments in the Central Denmark Region. Inter-rater reliability was investigated through parallel observations. A total of 108 children and 69 nurses participated. Two nurses simultaneously performed a PEWS assessment on the same patient. Before the assessment, the two participating nurses drew lots to decide who would be the active observer. Intraclass correlation coefficient, Fleiss' κ and Bland-Altman limits of agreement were used to determine inter-rater reliability. The intraclass correlation coefficients for the aggregated PEWS score of the two PEWS models were 0.98 and 0.95, respectively. The κ value on the individual PEWS measurements ranged from 0.70 to 1.0, indicating good to very good agreement. The nurses assigned the exact same aggregated score for both PEWS models in 76% of the cases. In 98% of the PEWS assessments, the aggregated PEWS scores assigned by the nurses were equal to or below 1 point in both models. The study showed good to very good inter-rater reliability in the two PEWS models used in the Central Denmark Region.

Evaluating pediatric early warning score (PEWS) as a predictor of PICU admission for children visiting emergency department in a tertiary care health centre

Objectives: To obtain cut-off values of PEWS scores that can predict need for PICU transfer at admission. To obtain cut-off values of PEWS scores that can predict unanticipated worsening (PICU transfer from ward after admission) Materials and methods: This was a prospective 12 month observational study of patients aged 1month to12 years admitted in our Emergency department. Approximately 738 patients were included in our study and all were subjected to PEWS score individually by the nurses and the pediatric trainee. Interrater reliability between nurses and pediatric trainee was evaluated. PEWS score was measured at initial assessment (S0) by pediatric trainee and staff nurse in emergency and after one hour (S1) by pediatric trainee alone. Patients were stratified into 3 outcome groups: those admitted to PICU either from ED, transferred from the ward, or those directly admitted to ward from ED. PEWS score was calculated and compared among the groups. Results: Among 1525 patients, 738(48%) were admitted, 252(34.12%) to PICU and 486(65.85%) to ward. AUC for predicting overall admission was 0.69 (95%CI: 0.68–0.77), for PICU 0.86 (95%CI:0.96–1) and for ward 0.75 (95%CI: 0.66-0.75). The sensitivity and specificity in predicting overall admission with cut off of PEWS≥ 1.5 was 76% and 64%, for PICU admission with cut off PEWS ≥ 3 was 100% and 90%, for ward admission with cut off PEWS ≥1.5 was 79% and 61% respectively. Interrater reliability was excellent . Conclusions: The study found elevated PEWS serve as excellent screening tool for prediction to PICU admission and transfer from ward to PICU

Predicting unplanned readmissions to a pediatric cardiac intensive care unit using predischarge Pediatric Early Warning Scores.

Unplanned readmission to the pediatric cardiac intensive care unit (CICU) is associated with significant morbidity and mortality. The Pediatric Early Warning Score (PEWS) predicts ward patients at risk for decompensation but has not been previously reported to identify at-risk patients with cardiac disease prior to ward transfer. This study aimed to determine whether PEWS prior to transfer may serve as a predictor of unplanned readmission to the CICU. All patients discharged from a tertiary children's hospital CICU from September 2012 through August 2015 were included for analysis. PEWS assessment was performed following transfer to the cardiac ward, and starting in January 2014, PEWS scores were also assigned by bedside CICU nurse prior to transfer from the CICU. Scores exceeding a predetermined threshold prompted further stability assessment by provider team prior to transfer. Among 1320 discharges of 1082 patients during the study period, there were 130 unplanned readmissions during their hospitalization. Following implementation of pretransfer PEWS scoring, there was no significant reduction in unplanned readmission frequency (10.2% vs 9.2%, P = .39). A secondary analysis of PEWS scores revealed cardiac scoring as a strong discriminator of those likely to experience an unplanned readmission, independent of other significant clinical predictors of readmission (OR 1.78, 95% CI 1.17-2.71, P = .007). The resultant multivariate model was a good predictor of unplanned readmission (AUC 0.77, 95% CI 0.71-0.83, P < .001). While implementation of a pretransfer PEWS assessment did not reduce the frequency of unplanned readmissions in this small single-center cohort, a multivariate model including pretransfer elements of an early warning scoring system, along with other patient characteristics serves as a good discriminator of patients likely to experience an unplanned readmission following CICU discharge. Further prospective investigation is needed to define objective measures of pretransfer discharge readiness to potentially reduce the likelihood of unplanned readmissions.

Validation of the Children's Hospital Early Warning System for Critical Deterioration Recognition

ObjectiveEarly warning scores, such as the Children's Hospital Early Warning Score (CHEWS), are used by hospitals to identify patients at risk for critical deterioration and trigger clinicians to intervene and prevent further deterioration. This study's objectives were to validate the CHEWS and to compare the CHEWS to the previously validated Brighton Pediatric Early Warning Score (PEWS) for early detection of critical deterioration in hospitalized, non-cardiac patients at a pediatric hospital. Design and MethodsA retrospective cohort study reviewed medical and surgical patients at a quaternary academic pediatric hospital. CHEWS scores and abstracted PEWS scores were obtained on cases (n=360) and a randomly selected comparison sample (n=776). Specificity, sensitivity, area under the receiver-operating characteristic curves (AUROC) and early warning times were calculated for both scoring tools. ResultsThe AUROC for CHEWS was 0.902 compared to 0.798 for PEWS (p<0.001). Sensitivity for scores ≥3 was 91.4% for CHEWS and 73.6% for PEWS with specificity of 67.8% for CHEWS and 88.5% for PEWS. Sensitivity for scores ≥5 was 75.6% for CHEWS and 38.9% for PEWS with specificity of 88.5% for CHEWS and 93.9% for PEWS. The early warning time from critical score (≥5) to critical deterioration was 3.8h for CHEWS versus 0.6h for PEWS (p<0.001). ConclusionThe CHEWS system demonstrated higher discrimination, higher sensitivity and longer early warning time than the PEWS for identifying children at risk for critical deterioration.

Pediatric Early Warning Score and unplanned readmission to the pediatric intensive care unit

Background and ObjectivesEarly unplanned Pediatric Intensive Care Unit (PICU) readmission is associated with greater length of stay and mortality. No tools exist to identify children at risk for PICU readmission. The Pediatric Early Warning Score (PEWS) currently identify children at risk for deterioration on the ward. Our primary objective was to evaluate the ability of PEWS to identify children at risk for unplanned PICU readmission. MethodsA single-center case-control study of 189 children (38 cases and 151 age-matched controls) 18years or younger transferred from the PICU to the pediatric ward from January 1, 2010-March 30, 2013, at an urban tertiary care children's hospital was conducted. ResultsThirty-eight cases had unplanned PICU readmission within 48hours of transfer to pediatric ward, whereas 151 controls were not readmitted. The PEWS assigned prior to PICU discharge and first PEWS assigned on the ward were collected for cases and controls. Each 1-point increase in the PEWS score significantly increased risk of PICU readmission (odds ratios [95% confidence intervals], 1.6 [1.12-2.27; P = .009] and 1.89 [1.33-2.69; P < .001], respectively). Discrimination ability of PEWS for PICU readmission improved when chronic diagnoses were included. ConclusionsHigher PEWS scores were associated with increased risk of unplanned PICU readmission. However, cutoff scores are not sensitive or specific enough to be clinically useful. Adding chronic disease variables may improve the clinical utility of cutoff PEWS scores.

Validation of an Early Warning Scoring Tool for the Identification of Pediatric Patients at Risk for Cardiopulmonary Arrest

Most inpatient pediatric arrests are preventable by early recognition/treatment of deterioration. Early warning scoring (EWS) systems provide early identification of children at arrest risk. In 2009, the Children’s Hospital Early Warning Score (CHEWS) was developed and validated in a single center of pediatric cardiac patients. To further validate the Children’s Hospital Early Warning Score tool and algorithm in inpatient pediatric non- cardiac patients. Nurses assess and document patients’ CHEWS scores during routine vital signs. An escalation of care algorithm directs either: routine care (score 0-2), increased assessment/intervention (3-4), or ICU consult/transfer (≥5). Sensitivity and specificity were estimated from a retrospective review of patients admitted to our inpatient units over 12 months who experienced arrest or unplanned ICU transfer (n=360) and a randomized comparison sample (n=776) of admissions. All patients in non-ICU or critical care areas that experienced an unplanned arrest or ICU transfer were included, patients at end of life with anticipated death were excluded from the case sample. All patients admitted to non-ICU or critical care were considered for inclusion for comparison control sample. The previously validated Pediatric Early Warning Score (PEWS) tool was used for comparison. Patients’ highest CHEWS scores were compared to calculated PEWS scores. Area under the receiver operating characteristic (AUROC) curve was calculated for PEWS and CHEWS to measure discrimination. CHEWS algorithm sensitivity was 97.8 (≥2), 84.2 (≥4) and 75.6 (≥5) versus PEWS of 82.8 (≥2), 54.4 (≥4), and 38.9 (≥5). CHEWS specificity was 52.5 (≥2), 80.9 (≥4), and 88.5 (≥5) versus PEWS of 63.7 (≥ 2), 85.3 (≥4) and 93.9 (≥5). The AUROC curve for CHEWS was 0.902 compared to PEWS 0.798. In this single center examination, the CHEWS demonstrated a higher discrimination and sensitivity than the PEWS in identifying deterioration in hospitalized children.

ABSTRACT 972

Background and aims: Unplanned Pediatric Intensive Care Unit (PICU) readmission is associated with greater length of ICU stay and mortality. Identifying children at risk of ICU readmission will enable earlier interventions for high-risk populations. The Pediatric Early Warning Score (PEWS), developed to identify children at risk of clinical deterioration, combines risk factors found previously to be associated with unplanned PICU readmission. Aims: Our primary aim is to evaluate association of PEWS with unplanned PICU readmission. Methods: Institutional Review Board approval included waiver of informed consent for this single-center case-control study. Children ≤ 18 years transferred from the PICU to the Pediatric Ward from 1/10 to 3/13 were screened. Cases had unplanned PICU readmission within 48 hours of transfer. Controls were not readmitted. PEWS scores assigned in the PICU (≤4 hours prior to transfer) and first PEWS scores assigned on the Pediatric Ward (≤4 hours after transfer) were collected for cases and controls. Multivariate logistic regression was used to generate odds ratios and 95% confidence intervals and test association of PEWS with unplanned PICU readmission, adjusted for age. Results: PEWS prior to PICU discharge and first PEWS on the Pediatric Ward were higher for readmitted vs. non-readmitted patients [median(IQR), 2(1,3) vs. 1(1,2);P=0.005] and [2(2,3) vs. 1(1,2);P=0.005], respectively. PEWS prior to PICU discharge and first PEWS on the Pediatric Ward were significantly associated with PICU readmission [adjusted OR (95%CI), 2.2(1.3-3.5);P=0.002] and [2.4(1.5-4.0);P<0.001], respectively. Conclusions: PEWS prior to PICU discharge and first PEWS on the Pediatric Ward can help identify children at high risk of PICU readmission.

G232(P) Prevalence of elevated PEWS scores in a Specialist Children’s Hospital: snapshot audit

IntroductionEarly Warning Scores are associated with an increase in early detection of illness (true positive), high scores without clinical deterioration (false positive) and clinician over-ride or alarm fatigue that leads...

Validation of the Cardiac Children's Hospital Early Warning Score: An Early Warning Scoring Tool to Prevent Cardiopulmonary Arrests in Children with Heart Disease

Most inpatient pediatric arrests are preventable by early recognition/treatment of deterioration. Children with cardiac disease have the highest arrest rates; however, early warning scoring systems have not been validated in this population. The objective of this study was to validate the Cardiac Children's Hospital Early Warning Score (C-CHEWS) tool in inpatient pediatric cardiac patients. The associated escalation of care algorithm directs: routine care (score 0-2), increased assessment/intervention (3-4), or cardiac intensive care unit (CICU) consult/transfer (≥5). Sensitivity and specificity were estimated based on retrospective review of patients that experienced unplanned CICU transfer/arrest (n = 64) and a comparison sample (n = 248) of admissions. The previously validated Pediatric Early Warning Score (PEWS) tool was used for comparison. Patients' highest C-CHEWS scores were compared with calculated PEWS scores. Area under the receiver operating characteristic (AUROC) curve was calculated for PEWS and C-CHEWS to measure discrimination. The AUROC curve for C-CHEWS was 0.917 compared with PEWS 0.785 (P < .001). The algorithm AUROC curve was 0.902 vs. PEWS of 0.782. C-CHEWS algorithm sensitivity was 96.9 (score ≥ 2), 79.7 (≥4), and 67.2 (≥5) vs. PEWS of 81.1(≥2), 37.5 (≥4), and 23.4 (≥5). C-CHEWS specificity was 58.1 (≥2), 85.5 (≥4), and 93.6 (≥5) vs. PEWS of 81.1 (≥2), 94.8 (≥4) and 97.6 (≥5). Lead time of elevated C-CHEWS scores (≥2) was a median of 9.25 hours prior to event vs. PEWS, which was 2.25 hours and lead time for critical C-CHEWS scores (≥5) was 2 hours vs. 0 hours for PEWS (P < .001). C-CHEWS has excellent discrimination to identify deterioration in children with cardiac disease and performed significantly better than PEWS both as an ordinal variable and when choosing cut points to maximize AUROC. C-CHEWS has a higher sensitivity than PEWS at all cut points.

Antibiotic use for febrile neutropaenia in children with cancer

ObjectivesTo assess if the antibiotic regimens being instituted are according to the NUH febrile neutropaenia guideline. To determine if gentamicin levels are being taken appropriately and are within recommended limits....

Can paediatric early warning score be used as a triage tool in paediatric accident and emergency?

The UK paediatric early warning score (PEWS) was developed for inpatients, looking at admission to the HDU and PICU and trying to produce a system which would recognize those children at risk of admission. Since the introduction of the '4-h wait', accident and emergency (A&E) departments have been under increasing strain to assess, treat and admit patients (if required) as quickly as possible. We designed this study with the view of identifying if the PEWS score could be used as a triage tool, to detect those patients who will need admission and therefore speed up the process of admitting children to the ward. All patients who visited A&E from 1st October-16th October 2006 were audited. The PEWS scores were collated after the study period. 774 children attended A&E during the study period. 316 patients were sent home from triage following nurse-led treatment or sent to another facility. Of the 458 patients remaining, 424 (93%) were included in the study - the only exclusion criterion was the failure of complete documentation of observations. The sensitivity [the probability of a child being admitted with a score of (n)] and the specificity (the probability of a patient not being admitted with a score of 0) were calculated. For all children aged 0-16 years, a PEWS score of >or=4 had a sensitivity of 24% and a specificity of 96%. A PEWS score of >or=2 had a sensitivity of 37% and a specificity of 88%. PEWS is of limited value in predicting admission (in a triage setting) in a population of undifferentiated disease. However, a low PEWS score has a high specificity, that is, a patient scoring <2 is unlikely to need admission.