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SCP: Paediatric Early Warning Scores (PEWS)
Summary of evidence for effectiveness

A systematic review by Chapman et al from 2010 investigated the validity, reliability, clinical effectiveness and clinical utility of published paediatric alert criteria. With the umbrella term “paediatric alert criteria” the authors meant either Early Warning Scores/systems, or activation/trigger criteria to mobilise a Rapid Response Team in hospitalized children cared for on wards outside the critical care unit.

Eleven studies fulfilled the inclusion criteria and described ten paediatric alert criteria. Six studies described the introduction and use of paediatric alert criteria as part of the implementation of a Rapid Response Team or equivalent system, four examined the development and testing of the paediatric alert criteria, and one investigated both aspects.

Of the five papers which described the development and testing, only three reported accurate values for positive predictive value, sensitivity and specificity. Only one study evaluated reliability, and none evaluated the clinical utility of the criteria. No study reported the impact of introducing paediatric alert criteria on patient outcome, although five papers described the effect of the Rapid Response Team activated as a result of the paediatric alert criteria on rates of cardiac arrest, respiratory arrest and hospital-wide mortality rates.

All paediatric alert criteria contained a measure of consciousness, and the majority included a measure of respiratory rate, heart rate and oxygen saturation. Overall, there was a lack of consistency in the number and type of parameters in the paediatric alert criteria, and in the thresholds for action by health care staff. Where tools were age dependent, there was a lack of agreement on age groupings. The authors note that this diversity limits comparison between studies and undermines the development of an evidence base for paediatric alert criteria.

The authors come to the conclusion that the evidence supporting the validity, reliability and utility of paediatric alert criteria is weak. Studies with a prospective evaluation of these parameters are needed. A more homogenous approach to paediatric alert criteria may produce wider benefits, in terms of training, clinical practice and research.

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