Pediatric Early Warning System Score Research Articles

Development of the national Dutch PEWS: the challenge against heterogeneity and implementation difficulties of PEWS in the Netherlands

BackgroundFor the early recognition of deteriorating patients several Pediatric Early Warning Score (PEWS) systems have been developed with the assumption that early detection can prevent further deterioration. Although PEWS are widely being used in hospitals in the Netherlands, there is no national consensus on which score to use and how to embed the score into a PEWS system. This resulted in a substantial heterogeneity of PEWS systems, of which many are unvalidated or self-designed. The primary objective of this study was to develop a pragmatic consensus-based PEWS system that can be utilized in all Dutch hospitals (University Medical Centers, teaching hospitals, and general hospitals).MethodsThis study is an iterative mixed-methods study. The methods from the Core Outcome Measures in Effectiveness Trials (COMET) initiative were used and consisted of two Delphi rounds, two inventories set out to all Dutch hospitals and a focus group session with parents. The study was guided by five expert meetings with different stakeholders and a final consensus meeting that resulted in a core PEWS set.ResultsThe first Delphi round was completed by 292 healthcare professionals, consisting of pediatric nurses and physicians. In the second Delphi round 217 healthcare professionals participated. Eventually, the core PEWS set was been developed comprising of the parameters work of breathing, respiratory rate, oxygen therapy, heart rate and capillary refill time, and AVPU (Alert, Verbal, Pain, and Unresponsive). In addition, risk stratification was added to the core set with standardized risk factors consisting of [1] worried signs from healthcare professionals and parents and [2] high-risk treatment, with the option to add applicable local defined risk factors. Lastly, the three categories of risk stratification were defined (standard, medium, and high risk) in combination with standardized actions of the professionals for each category.ConclusionThis study demonstrates a way to end a country’s struggle with PEWS heterogeneity by co-designing a national Dutch PEWS system. Currently, the power of the system is being investigated in a large multi-center study in the Netherlands.

Reliability and validity of Chengdu pediatric emergency triage criteria: case study of a single center in China

BackgroundWe aimed to examine the reliability and validity of Chengdu pediatric emergency triage criteria in order to provide a reference for the development of pediatric emergency triage within other hospitals.MethodsWe developed Chengdu pediatric emergency triage criteria based on the conditions/symptom, vital signs, and the Pediatric Early Warning Score system within our hospital using the Delphi method in 2020. The simulation scenario triage and real-life triage which were conducted in our hospital during January - March 2021, and the retrospective study of triage records extracted from our hospital’s health information system in February 2022, were used to measure the agreement in triage decisions between the triage nurses, and between the triage nurses and the expert team.ResultsFor the 20 simulation cases, the Kappa value of triage decisions between the triage nurses was 0.6 (95% CI 0.352–0.849), and the Kappa value of triage decisions between the triage nurses and the expert team was 0.73 (95% CI 0.540–0.911). For the 252 cases in the real-life triage, the Kappa value of triage decisions between the triage nurses and the expert team was 0.824 (95% CI 0.680–0.962). For the 20,540 cases selected for the retrospective study of triage records, the Kappa value of triage decisions between the triage nurses was 0.702 (95% CI 0.691–0.713); that between Triage Nurse 1 and the expert team was 0.634 (95% CI 0.623–0.647); and that between Triage Nurse 2 and the expert team was 0.725 (95% CI 0.713–0.736). The overall agreement rate in triage decisions between the triage nurses and the expert team in the simulation scenario triage was 80%; that between the triage nurses and the expert team in the real-life triage was 97.6%; and that between the triage nurses in the retrospective study was 91.9%. In the retrospective study, the agreement rates in triage decisions between Triage Nurse 1 and the expert team, and between Triage Nurse 2 and the expert team, were 88.0% and 92.3%, respectively.ConclusionChengdu pediatric emergency triage criteria that developed within our hospital is reliable and valid, and can promote rapid and effective triage by triage nurses.

The value of Pediatric Early Warning Score combined with SBAR in neonatal pneumonia nursing: A retrospective cohort study.

To observe the effect of the Pediatric Early Warning System (PEWS) score combined with the situation-background-assessment-recommendation (SBAR) shift communication system in neonates with severe pneumonia in the pediatric intensive care unit. A total of 230 neonates admitted to the pediatric intensive care unit of our hospital from January 2018 to January 2021 were enrolled in this study. Participants were divided into an experimental group (110 patients, PEWS score combined with SBAR shift communication system) and a control group (120 patients, routine diagnosis and treatment and shift change). The early recognition rate, incidence of handover problems, and prognosis of critically ill children in the 2 groups were analyzed. Compared to the control group, the correct recognition rate of disease observation and early recognition rate of critically ill children in the experimental group were significantly higher, and the incidence of handover problems was significantly lower (P < .05). There was no significant difference in the incidence of asphyxia, heart failure, and toxic encephalopathy between both groups. The application of the PEWS score combined with the SBAR shift communication system can facilitate timely identification of deterioration of the condition of children with severe pneumonia, reduce handover problems, and help to implement interventions or rescue according to the changes in a patient's condition, which may be beneficial in improving the patient's prognosis.

MORTALITY PROFILE AND ITS CORRELATION WITH BPEWS SCORE IN PEDIATRIC INTENSIVE CARE UNIT OF TERTIARY CARE CENTRE

Introduction: The care of critically ill children remains one of the most demanding and challenging aspects in the field of Pediatrics. In spite of availability of well-equipped Pediatric Intensive Care Units (PICU), deaths do occur. Aims/objective:To study the mortality profiles and its correlation to the Bedside Pediatric Early Warning System Score (BPEWS) in children who expired within 48 hours of admission.Inclusion criteria:children aged1 month to 12 years who expired within 48 hours of admission in PICU of a tertiary care center.Methods:Approval from the institutional ethics committee was obtained prior to commencement of the study.Retrospective data of consecutive children aged 1 month to 12 years who expired within 48 hours, was collected from the hospital's Medical Records Section. The variables necessary for BPEWS Score calculator were noted and the BPEWS Score was calculated. Result: 84% patients were below five years of age with mean age of 2.6 year and 57% were females. Mean duration of stay was 19.68 hours. Mean distance from health facility was 8.31 km. Respiratory system was affected in the majority of patients (47%). More than forty percent of children were undernourished. Mean BPEWS score was 17.36 in the age group of 1 to 5 year, which depicts poor outcome. Conclusion: Majority of early deaths (within 48hrs) occurred in patients less than five years of age.Higher BPEWS (&gt;8) was associated with shorter duration of stay of patients and poor outcome

Arriving Safely: Decreasing Rapid Escalations in Care for Incoming Transported Pediatric Patients.

We created an escalation algorithm utilizing PEWS scores and direct lines of communication between emergency medical technicians and receiving physicians. Audit and feedback increased the adoption of the process. We defined rapid escalations as transfer to a higher level of care within 6 hours of admission. PEWS score completion increased from a mean of 48% to 70%. This result varied by emergency medical technician crew level of care. Eleven percent (n = 114) of PEWS scores required physician notification, 20% (n = 23) of which resulted in interventions en route. There were no differences in rapid escalation rates over time, but it remained low at <2% of all incoming transported patients. Some crew members report improved communication with hospital providers and feel more empowered to speak up when a patient's assessment is not as expected following algorithm implementation. This project improved PEWS score completion and maintained a low rate of rapid escalations of care among incoming transfers.

Validation of a modified bedside Pediatric Early Warning System score for detection of clinical deterioration in hospitalized pediatric oncology patients: A prospective cohort study.

Hospitalized pediatric oncology patients are at risk of severe clinical deterioration. Yet Pediatric Early Warning System (PEWS) scores have not been prospectively validated in these patients. We aimed to determine the predictive performance of the modified BedsidePEWS score for unplanned pediatric intensive care unit (PICU) admission and cardiopulmonary resuscitation (CPR) in this patient population. We performed a prospective cohort study in an 80-bed pediatric oncology hospital in the Netherlands, where care has been nationally centralized. All hospitalized pediatric oncology patients aged 0-18years were eligible for inclusion. A Cox proportional hazard model was estimated to study the association between BedsidePEWS score and unplanned PICU admissions or CPR. The predictive performance of the model was internally validated by bootstrapping. A total of 1137 patients were included. During the study, 103 patients experienced 127 unplanned PICU admissions and three CPRs. The hazard ratio for unplanned PICU admission or CPR was 1.65 (95% confidence interval [CI]: 1.59-1.72) for each point increase in the modified BedsidePEWS score. The discriminative ability was moderate (D-index close to 0 and a C-index of 0.83 [95% CI: 0.79-0.90]). Positive and negative predictive values of modified BedsidePEWS score at the widely used cutoff of 8, at which escalation of care is required, were 1.4% and 99.9%, respectively. The modified BedsidePEWS score is significantly associated with requirement of PICU transfer or CPR. In pediatric oncology patients, this PEWS score may aid in clinical decision-making for timing of PICU transfer.

The application of pediatric early warning score (PEWS) in emergency observation room

ObjectiveTo explore the value of pediatric early warning scoring system (PEWS) in an emergency observation room in China. MethodsThe children who had been admitted consecutively to the emergency observation room from Jan, 2019 to Aug, 2020 were selected. Three most important time-points including the first value (admission value), the highest value during the observation (highest value), and final value (discharge value) of Brighton Pediatric Early Warning Score (PEWS) was evaluated in all patients. Results4717 patients were included. They were categorized into 3 groups, namely, discharged group (G1, n = 2320), specialized ward group (G2, n = 2128), and ICU group (G3, n = 269). The different PEWS values of admission value, highest value, and discharge value were significantly different among the 3 groups (P<0.001). Highest value of G1 and G2 were significantly lower than that of G3 (P<0.001). AUROC curves of different PEWS values were used to predict the possibility of PICU admission and PICU mortality within 24 h of admission, and the values were 0.698, 0.878, 0.974 and 0.709, 0.883, 0.951, respectively. The cutoff values for PICU admission of 3 different PEWS values were 2.5 (sensitivity 0.635, specificity 0.699), 3.5 (sensitivity 0.817, specificity 0.9), 3.5 (sensitivity 0.837, specificity 0.985). The cutoff values for PICU mortality of 3 different PEWS values were 4 (sensitivity 0.625, specificity 0.799), 4.5 (sensitivity 0.722, specificity 0.79), 4.5 (sensitivity 0.883, specificity 0.987). The discharge value had the strongest prediction ability. ConclusionsPEWS can be used for early identification and warning of critically ill children.

Validation of the Computerized Pediatric Triage Tool, pediaTRI, in the Pediatric Emergency Department of Lenval Children's Hospital in Nice: A Cross-Sectional Observational Study.

IntroductionA reliable pediatric triage tool is essential for nurses working in pediatric emergency departments to quickly identify children requiring priority care (high-level emergencies) and those who can wait (low-level emergencies). In the absence of a gold standard in France, the objective of our study was to validate our 5-level pediatric triage tool –pediaTRI– against the reference tool: the Pediatric Early Warning Score (PEWS) System.Materials and MethodsWe prospectively included 100,506 children who visited the Pediatric Emergency Department at Lenval Children's Hospital (Nice, France) in 2016 and 2017. The performance of pediaTRI to identify high-level emergencies (severity levels 1 and 2) was evaluated in comparison with a PEWS ≥ 4/9. Data from 2018–19 was used as an independent validation cohort.ResultspediaTRI agreed with the PEWS score for 84,896 of the patients (84.5%): 15.0% (14.8–15.2) of the patients were over-triaged and 0.5% (0.5–0.6) under-triaged compared with the PEWS score. pediaTRI had a sensitivity of 76.4% (74.6–78.2), a specificity of 84.7% (84.4–84.9), and positive and negative likelihood ratios of 5.0 (4.8–5.1) and 0.3 (0.3–0.3), respectively, for the identification of high-level emergencies. However, the positive likelihood ratios were lower for patients presenting with a medical complaint [4.1 (4.0–4.2) v 10.4 (7.9–13.7 for trauma), and for younger children [1.2 (1.1–1.2) from 0 to 28 days, and 1.9 (1.8–2.0) from 28 days to 3 months].ConclusionpediaTRI has a moderate to good validity to triage children in a Pediatric Emergency Department with a tendency to over-triage compared with the PEWS system. Its validity is lower for younger children and for children consulting for a medical complaint.

Validation of a Modified Bedside Pediatric Early Warning System Score for Detection of Clinical Deterioration in Hospitalized Pediatric Oncology Patients: A Prospective Cohort Study

Validation of a Modified Bedside Pediatric Early Warning System Score for Detection of Clinical Deterioration in Hospitalized Pediatric Oncology Patients: A Prospective Cohort Study

A Quality Improvement Initiative to Reduce Unnecessary Rapid Responses Using Early Warning Scores

The Pediatric Early Warning Score (PEWS) is an evidence-based tool that allows early collaborative assessment and intervention for a rapid response team (RRT) activation. The goal of our quality improvement initiative was to reduce the percentage of unnecessary RRT activations by 50% over 2 years without increasing PICU transfers or compromising patient safety and timely evaluation. A PEWS system replaced preexisting vital signs-based pediatric RRT criteria and was modified through plan-do-study-act cycles. Unnecessary RRT activations, total RRT activation rate, transfers to the PICU, total clinical interventions performed per RRT, and missed RRT activation rate were compared between intervention periods. Likert scale surveys were administered to measure satisfaction with each modification. There was a significant decrease in the percentage of unnecessary RRT activations from 33% to 3.5% after the implementation of the PEWS and modified-PEWS systems (P < .05). The RRT activation rate decreased from 22.6 to 13.3 RRT activations per 1000 patient care days after implementation of the PEWS and modified-PEWS systems (P < .05), without changes in PICU transfer rates. Physicians reported that the PEWS system improved nursing communication and accuracy of RRT criteria (P < .05). Nursing reported that the PEWS system improved patient management and clinical autonomy (P < .05). The PEWS systems have been an effective means of identifying deteriorating pediatric patients and reducing unnecessary RRT activations. The new system fosters collaboration and communication at the bedside to prevent acute deterioration, perform timely interventions, and ultimately improve patient safety and outcomes.

Faktor-Faktor yang Berhubungan dengan Kejadian Luka Dekubitus Akibat Penggunaan Alat Medis di Ruang PICU

The use of medical devices in patients treated at the Pediatric Intensive Care Unit (PICU) is very high. Patients who are treated in intensive care are also at risk for medical device-related pressure injury (MDRPI). This study aimed to determine the factors associated with the incidence of MRDPI in the Pediatric Intensive Care Unit (PICU) RSUP DR. Wahidin Sudirohusodo Makassar. This study used an observational analytic method with a prospective cohort approach. The Sampling method used a simple random sampling of 76 people. This research was conducted on 8 May - 6 July 2019. The data collection technique used an observation sheet with the research instrument used in the form of the Pediatric Early Warning Scoring System to assess critical conditions, the level of awareness was fully used Full Outline of UnResponsiveness score (FOUR Score). The data were analyzed tested by using the statistical the Chi Square with a confidence level of 95%. All data were analyzed using the SPSS version 21.0 program (SPSS, Inc. Chicago, IL). Factors associated with the MDRPI incidence include critical conditions based on PEWSS (p = 0.002), level of awareness based on the FOUR Score (p = 0.025), number of devices installed (p = 0.015), and fixation techniques (p = 0.025). As for peripheral tissue perfusion (p = 0.268), albumin (p = 0.309), skin moisture (p = 0.888) were not related. Factors associated with the incidence of MDRPI include critical condition, level of awareness, number of devices installed, and fixation techniques. It’s recommended to make preventive efforts.

A Vital Sign-Based Model to Predict Clinical Deterioration in Hospitalized Children.

Clinical deterioration in hospitalized children is associated with increased risk of mortality and morbidity. A prediction model capable of accurate and early identification of pediatric patients at risk of deterioration can facilitate timely assessment and intervention, potentially improving survival and long-term outcomes. The objective of this study was to develop a model utilizing vital signs from electronic health record data for predicting clinical deterioration in pediatric ward patients. Observational cohort study. An urban, tertiary-care medical center. Patients less than 18 years admitted to the general ward during years 2009-2018. None. The primary outcome of clinical deterioration was defined as a direct ward-to-ICU transfer. A discrete-time logistic regression model utilizing six vital signs along with patient characteristics was developed to predict ICU transfers several hours in advance. Among 31,899 pediatric admissions, 1,375 (3.7%) experienced the outcome. Data were split into independent derivation (yr 2009-2014) and prospective validation (yr 2015-2018) cohorts. In the prospective validation cohort, the vital sign model significantly outperformed a modified version of the Bedside Pediatric Early Warning System score in predicting ICU transfers 12 hours prior to the event (C-statistic 0.78 vs 0.72; p < 0.01). We developed a model utilizing six commonly used vital signs to predict risk of deterioration in hospitalized children. Our model demonstrated greater accuracy in predicting ICU transfers than the modified Bedside Pediatric Early Warning System. Our model may promote opportunities for timelier intervention and risk mitigation, thereby decreasing preventable death and improving long-term health.

Single blood pressure chart for children up to 13 years to improve the recognition of hypertension based on existing normative data

ObjectiveTo produce a single ‘growth-chart-style’ blood pressure (BP) chart with clear diagnostic thresholds to assist paediatricians to make prompt and accurate diagnoses of hypertension.DesignThe well-established but complex published data on...

The Vitals Risk Index-Retrospective Performance Analysis of an Automated and Objective Pediatric Early Warning System.

Pediatric in-hospital cardiac arrests and emergent transfers to the pediatric intensive care unit (ICU) represent a serious patient safety concern with associated increased morbidity and mortality. Some institutions have turned to the electronic health record and predictive analytics in search of earlier and more accurate detection of patients at risk for decompensation. Objective electronic health record data from 2011 to 2017 was utilized to develop an automated early warning system score aimed at identifying hospitalized children at risk of clinical deterioration. Five vital sign measurements and supplemental oxygen requirement data were used to build the Vitals Risk Index (VRI) model, using multivariate logistic regression. We compared the VRI to the hospital's existing early warning system, an adaptation of Monaghan's Pediatric Early Warning Score system (PEWS). The patient population included hospitalized children 18 years of age and younger while being cared for outside of the ICU. This dataset included 158 case hospitalizations (102 emergent transfers to the ICU and 56 "code blue" events) and 135,597 control hospitalizations. When identifying deteriorating patients 2 hours before an event, there was no significant difference between Pediatric Early Warning Score and VRI's areas under the receiver operating characteristic curve at false-positive rates ≤ 10% (pAUC10 of 0.065 and 0.064, respectively; P = 0.74), a threshold chosen to compare the 2 approaches under clinically tolerable false-positive rates. The VRI represents an objective, simple, and automated predictive analytics tool for identifying hospitalized pediatric patients at risk of deteriorating outside of the ICU setting.

Implementation study of a 5-component pediatric early warning system (PEWS) in an emergency department in British Columbia, Canada, to inform provincial scale up

BackgroundThe rapid identification of deterioration in the pediatric population is complex, particularly in the emergency department (ED). A comprehensive multi-faceted Pediatric Early Warning System (PEWS) might maximize early recognition of clinical deterioration and provide a structured process for the reassessment and escalation of care. The objective of the study was to evaluate the implementation fidelity, effectiveness, and utility of a 5-component PEWS implemented in the ED of an urban public general hospital in British Columbia, Canada, and to guide provincial scale up.MethodsWe used a before-and-after design to evaluate the implementation fidelity, effectiveness, and utility of a 5-component PEWS (pediatric assessment flowsheet, PEWS score, situational awareness, escalation aid, and communication framework). Sources of data included patient medical records, surveys of direct care staff, and key-informant interviews. Data were analyzed using mixed-methods approaches.ResultsThe majority of medical records had documented PEWS scores at triage (80%) and first bedside assessment (81%), indicating that the intervention was implemented with high fidelity. The intervention was effective in increasing vital signs documentation, both at first beside assessment (84% increase) and throughout the ED stay (> 100% increase), in improving staff’s self-perceived knowledge and confidence in providing pediatric care, and self-reported communication between staff. Satisfaction levels were high with the PEWS scoring system, flowsheet, escalation aid, and to a lesser extent with the situational awareness tool and communication framework. Reasons for dissatisfaction included increased paperwork and incidence of false-positives. Overall, the majority of providers indicated that implementation of PEWS and completing a PEWS score at triage alongside the Canadian Triage and Acuity Scale (CTAS) added value to pediatric care in the ED. Results also suggest that the intervention is aligned with current practice in the ED.ConclusionOur study shows that high-fidelity implementation of PEWS in the ED is feasible. We also show that a multi-component PEWS can be effective in improving pediatric care and be well-accepted by staff. Results and lessons learned from this pilot study are being used to scale up implementation of PEWS in ED settings across the province of British Columbia.

Utility of Pediatric Early Warning Scoring System in Predicting Clinical Deterioration in Children: A Review

Utility of Pediatric Early Warning Scoring System in Predicting Clinical Deterioration in Children: A Review

Correlation of Bedside Pediatric Early Warning System Score to Interventions During Peritransport Period.

The Bedside Pediatric Early Warning System score is a validated measure of severity of illness in acute care inpatient settings. Its potential as a remote assessment tool for interfacility transport has not been evaluated. We hypothesized that the Bedside Pediatric Early Warning System score was associated with need for intervention during the peritransport period and patient disposition. We retrospectively evaluated children transported by a regional pediatric team during a 6-month period. Bedside Pediatric Early Warning System scores were calculated at the triage phone call, the transport team arrival, and at transfer of care to the hospital team. The primary outcome was the receipt of significant intervention during the peritransport period, with additional outcomes of destination (ICU, ward, emergency department) in the regional hospital. Scores are presented as median values (interquartile range). There were 564 children who underwent transport; 139 (25%) received interventions; and 205 (36%) were transferred to the PICU, 231 (41%) to the ward, and 127 (23%) to the emergency department. Scores were 2 (1-5; median interquartile range) in children receiving no in-transport interventions, 8 (5-11) in children receiving any intervention (p < 0.001), and 10 (7-14) in children receiving more than one intervention. Children transferred to the PICU had higher scores 6 (3-10), than children transferred to a ward 3 (1-6) or the emergency department 2 (1-3) (p < 0.001). The Bedside Pediatric Early Warning System score at the time of initial referral is a useful measure of severity of illness reflected by the subsequent provision of significant peritransport intervention and the transfer destination.

An assessment of a pediatric early warning system score in severe hand-foot-and-mouth disease children: To detect clinical deterioration in hospitalized children.

Identification of deteriorating severe hand, foot, and mouth disease (HFMD) children for referral to intensive care remains problematic.The medical records of 2382 hospitalized children with severe HFMD from May 2013 to September 2015 were retrospectively reviewed. A Pediatric Early Warning System (PEWS) score was designed based on study parameters on admission, evaluated in a logistic regression model, and subsequently validated with different cut-off scores, to predict the risk for clinical deterioration.After admission, 191 cases were transferred to the pediatric intensive care unit (PICU) and 2191 were admitted to the infectious disease department. Of which, 116 cases were subsequently transferred to PICU, with younger age, consciousness levels of sluggishness, lethargy or drowsiness, rashes with vesicles on the hands or feet, moderate or high fever, increased or disordered lung marking or pulmonary infiltration, abnormal heart rate, fasting plasma glucose, blood platelet, and C-reactive protein. A corresponding 10-component PEWS score >7 was significantly associated with subsequent transfer to PICU.A 10-component PEWS score >7 has good specificity but poor sensitivity for identifying severe HFMD children vulnerable to clinical deterioration.

Abstract O-55: THE APPLICATION OF PEDIATRIC EARLY WARNING SCORE(PEWS) IN EMERGENCY OBSERVATION ROOM

Aims & Objectives: To assess the ability of pediatric early warning scoring system (PEWS) to recognize the critically ill children in emergency observation room Methods We collected those patients’ general information (including gender, age, disease diagnosis), and different points of PEWS(admission, the highest, discharge), and different outcomes, and prognosis(survival or death of those admitted in PICU) Results A total of 4744 children(male 62.9%) were enrolled and categorized into 4 groups according to their different outcomes namely, discharged group(G1, n=2320), specialized ward group(G2, n=2128), ICU group(G3, n=269), and spontaneous discharge group(G4, n=27). The diagnosis of those patients was divided into 17 categories. There was no significant difference in gender between four groups. Children in G4 were younger and those who had tumor diseases had the highest proportion of admission to PICU. The different PEWS scores were statistically significant among the four different groups (P < 0.001). Neither the first scores nor the highest ones had significant difference between G1 and G2, but contrarily between G1 and G3, as well as G2 and G3. The discharge scores were different between any two groups. We use AUROC curve to predict the possibility of PICU admission and the corresponding death, and the values were 0.698, 0.878, 0.974 and 0.709, 0.883, 0.951, respectively. Their corresponding cut-off values were 2.5, 3.5, 3.5 and 1.5, 3.5, 3.5, respectively. The discharge scores had the strongest prediction ability and highest specificity and sensitivity. Conclusions PEWS can be used for early identification of critically ill children or potential ones

Pediatric Rapid Response Team: Vital Sign-Based System vs. Pediatric Early Warning Score System

Pediatric Rapid Response Team: Vital Sign-Based System vs. Pediatric Early Warning Score System