Article Text

Download PDFPDF
Question 2: Can paediatric early warning systems predict serious clinical deterioration in paediatric inpatients?
  1. Lynn Sinitsky1,
  2. Ashley Reece2
  1. 1 Department of General Paediatrics, Barnet General Hospital, Royal Free London NHS Foundation Trust, London, UK
  2. 2 Department of Paediatrics, Watford General Hospital, West Hertfordshire Hospitals NHS Trust, Watford, UK
  1. Correspondence to Dr Ashley Reece, Department of Paediatrics, Watford General Hospital, West Hertfordshire Hospitals NHS Trust, Watford WD18 0HB, UK; ashley.reece{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Clinical scenario

A 3-year-old boy presents to his local district general hospital with a 1-day history of fever and shortness of breath. He is admitted to the paediatric ward for ongoing observation and management. The nursing staff calculate a paediatric early warning score (PEWS), based on physiological parameters, with each set of nursing observations. The student nurse on the ward notices that your chart is different from the one used by the paediatric ward on her last placement. She asks you how accurately paediatric early warning scoring systems predict serious clinical deterioration, particularly cardiopulmonary arrest (CPA), paediatric intensive care admission or paediatric high-dependency care admission.

Clinical question

In paediatric inpatients, can a paediatric early warning trigger or scoring system predict serious clinical deterioration?


Medline 1950 to present from PubMed

Cochrane Library Issue 9, September 2014

Search terms used: ((‘pediatrics’[MeSH Terms] OR ‘pediatrics’[All Fields] OR ‘paediatric’[All Fields]) OR (‘pediatrics’[MeSH Terms] OR ‘pediatrics’[All Fields] OR ‘pediatric’[All Fields])) AND (early[All Fields] AND warning[All Fields]) AND ((‘Sentinel Event Alert’[Journal] OR ‘alert’[All Fields]) AND (‘standards’[Subheading] OR ‘standards’[All Fields] OR ‘criteria’[All Fields]))

No limits were placed on the search.

Studies conducted on paediatric inpatient populations, aged 0–16 years, in developed countries were included.

One systematic review, 12 papers validating PEWS in paediatric inpatients were found. Five …

View Full Text


  • Contributors LS conceived the idea for this best evidence topic and performed the literature search. LS drafted the article and AR revised it critically. All authors interpreted the data and approved the final manuscript. AR is the guarantor.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles