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Paediatric early warning systems (PEWS and Trigger systems) for the hospitalised child: time to focus on the evidence
  1. Peter J Lillitos1,
  2. Ian K Maconochie1,2
  1. 1Department of Emergency Medicine, Imperial College NHS Trust, St Mary's Hospital, London, UK
  2. 2Faculty of Medicine, Imperial College, London, UK
  1. Correspondence to Dr Peter J Lillitos, Department of Emergency Medicine, Imperial College NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK; plillitos{at}

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Paediatric early warning systems (PES) detect trends of abnormality and indicate the need for care escalation, the extent of which depending on the value of score, for example, from nursing review to consultant input being required. Two broad systems exist: Trigger systems and early warning scores (PEWS). Trigger systems operate in an ‘all or nothing’ fashion as they activate an urgent clinical review when one of the trigger criteria is reported. PEWS systems assign an aggregated score according to the degree of physiological derangement and the presence or absence of other factors such as staff or carer concern and comorbidities of patients. Over a decade ago, a number of hospital serious case reviews into child deaths identified contributory factors being deficiencies in clinical assessment and the failure to act on deteriorating vital signs. In response, the UK National Patient Safety Agency, National Institute for Health and Clinical Excellence, together with the UK Confidential Enquiry into Maternal and Child Health report ‘Why Children Die’ made recommendations for the use of early warning systems. The recommendations have been broadly implemented with the proportion of UK paediatric hospital units using PES rising from <25% in 2005 to 85% in 2012.1 During the same period, a proliferation in the types of PES have occurred since the introduction and validation of the Brighton score in …

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  • Contributors PJL was the main author. IKM reviewed and edited the manuscript.

  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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