• Measurement
• Monitoring
• Physiology
• Respiratory
• Cardiology

In 2008, the Confidential Enquiry into Maternal and Child Health report, Why Children Die: A Pilot Study 2006, highlighted the need for health professionals to be able to identify a sick child and recommended greater use and awareness of validated scoring systems to identify acutely ill children. They made this recommendation based on their findings that a quarter of child deaths were preventable and “a major factor [relating to these deaths] was shortcomings in the recognition and management of the acutely ill child”.1

The key word used here is ‘validated’: there are a variety of paediatric early warning scores (PEWS), most of which are physiology based systems that either produce a numerical score associated with the risk of a patient deteriorating or track a patient's physiological condition and trigger the need for intervention at some threshold.2 A primary focus in the development of PEWS has been the establishment of reference ranges for physiological parameters such as heart rate, respiratory rate and systolic blood pressure alongside other factors that may contribute to an algorithm that will allow medical and nursing staff to identify abnormal symptoms before the child becomes critically ill. As Fleming et al3 noted in 2011, the reference ranges at that time were not evidence-based. This is reflected in the assessment of the validity of different PEWS scores in the emergency department in which Sieger …