Paediatric early warning score: Good tool for clinical practice

N. Suganya Periya Nayagi

Nursing Incharge, Maa Kauvery, Trichy, Tamil Nadu

Background

Objectives

From this module we can learn about,

Paediatric Early Warning Score
Benefits of PEWS
Assessment of PEWS

Pediatric Early Warning Score

The Pediatric Early Warning Score (PEWS) is designed to enable health care professionals to recognize “Child at risk” and to trigger early referral to medical staff, so that early intervention can help to prevent deterioration.

Benefits of PEWS

Ensure a full set of observations are recorded and repeated as necessary
Empower staff
Aid recognition of sick/deteriorating children
Documented trends of patient improvement or deterioration
Reduce the amount of unexpected PICU admissions.
Reduce the number or ‘unexpected’ (undetected) cardio respiratory arrests

PEWS -Pediatric Early Warning Score

S. NO	Behaviour		Cardiovascular		Respiratory
1	• Playing • Alert • Appropriate • At Baseline	0	• Pink • Capillary Refill 1–2 seconds	0	• Within Normal Parameters	0
2	• Sleepy • Fussy but consolable	1	• Pale • Capillary Refill 3 seconds	1	• Rate >10 BPM above normal • Accessory muscle use • 30%+ FiO2 • 3+ L/Min O2	1
3	• Irritable or Inconsolable	2	• Grey • Capillary Refill 4 seconds • Tachycardia >20 BPM above normal	2	• Rate >20 BPM above normal • Retractions • 40%+ FiO2 • 6+ L/Min O2 • O2 saturation 5% below baseline	2
4	• Lethargic • Confused • Reduced Response to pain	3	• Grey • Mottled • Capillary Refill ≥5 seconds • Tachycardia >30 BPM above normal • Bradycardia	3	• Below normal rate • Retractions • Grunting • 50%+ FiO2 • 8+ L/Min O2 • O2 saturation >5% below baseline	3

Assessment

Score – 0 Reassess 4^th Hourly
Score – 1 – 3 Reassess 2^nd Hourly
Score – 4 – 6 Reassess Hourly
Score > 7 Every 30 Min/Urgent attention required

Behavior

Score 0	Score 1	Score 2	Score 3
Playing	Sleepy	Irritable or Inconsolable	Lethargic
Alert	Fussy but Consolable		Confused
Appropriate			Reduced Response to Pain
At Baseline

Cardio Vascular

Score 0	Score 1	Score 2	Score 3
Pink	Pale	Grey	Grey
Capillary refill 1-2 seconds	Capillary refill 3 seconds	Capillary refill 4 seconds	Mottled
		Tachycardia 20 BPM above normal rate	Capillary refill 5 seconds or above
			Tachycardia 30 BPM above normal rate
			Bradycardia

Respiratory

Score 0	Score 1	Score 2	Score 3
Within normal parameters	Rate greater than 10 BPM above normal	Rate greater than 20 above normal	Below normal rate
	Accessory muscle use	Retractions	Retractions
	30% + FIO2	40% + FIO2	Grunting
	3+ L/min. O2	6+ L/min. O2	50% + FIO2
		O2 saturation 5% below baseline	8+ L/min. O2
			O2 Saturation greater than 5% below baseline

What to do Next?

Score 0	Score 1 - 3-3	Score 4 - 64-6	Score > 7
Reassess Q4 hourly	Reassess Q2 hourly	Reassess hourly	Every 30minutes Urgent attention required

Over View

From this module we have learnt about paediatric early warning score, assessment and management.

Paediatric early warning score: Good tool for clinical practice

Paediatric early warning score: Good tool for clinical practice

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