Research
Development and initial validation of the Bedside Paediatric Early Warning System score
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* Corresponding author: Christopher S Parshuram christopher.parshuram@sickkids.ca
1 Department of Critical Care Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
2 Department of Pediatrics, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
3 Child Health and Evaluation Sciences Program, The Research Institute, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
4 Centre for Safety Research, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
5 Department of Pediatrics, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada
6 Interdepartmental Division of Critical Care Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada
7 Department of Health Policy Management and Evaluation, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada
Critical Care 2009, 13:R135 doi:10.1186/cc7998
Published: 12 August 2009Abstract
Introduction
Adverse outcomes following clinical deterioration in children admitted to hospital wards is frequently preventable. Identification of children for referral to critical care experts remains problematic. Our objective was to develop and validate a simple bedside score to quantify severity of illness in hospitalized children.
Methods
A case-control design was used to evaluate 11 candidate items and identify a pragmatic score for routine bedside use. Case-patients were urgently admitted to the intensive care unit (ICU). Control-patients had no 'code blue', ICU admission or care restrictions. Validation was performed using two prospectively collected datasets.
Results
Data from 60 case and 120 control-patients was obtained. Four out of eleven candidate-items were removed. The seven-item Bedside Paediatric Early Warning System (PEWS) score ranges from 0–26. The mean maximum scores were 10.1 in case-patients and 3.4 in control-patients. The area under the receiver operating characteristics curve was 0.91, compared with 0.84 for the retrospective nurse-rating of patient risk for near or actual cardiopulmonary arrest. At a score of 8 the sensitivity and specificity were 82% and 93%, respectively. The score increased over 24 hours preceding urgent paediatric intensive care unit (PICU) admission (P < 0.0001). In 436 urgent consultations, the Bedside PEWS score was higher in patients admitted to the ICU than patients who were not admitted (P < 0.0001).
Conclusions
We developed and performed the initial validation of the Bedside PEWS score. This 7-item score can quantify severity of illness in hospitalized children and identify critically ill children with at least one hours notice. Prospective validation in other populations is required before clinical application.