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Missed opportunities: incomplete and inaccurate recording of paediatric early warning scores
  1. Susan M Chapman1,2,
  2. Kate Oulton3,
  3. Mark John Peters2,4,
  4. Jo Wray3
  1. 1 International and Private Patients, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  2. 2 Respiratory, Critical Care and Anaesthesia Unit, UCL Great Ormond Street Institute of Child Health, London, UK
  3. 3 Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  4. 4 Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  1. Correspondence to Dr Susan M Chapman, International and Private Patients, Great Ormond Street Hospital, London WC1N 3JH, UK; Sue.Chapman{at}


Background Paediatric early warning scores (PEWS) are widely used as an adjunct to support staff in recognising deterioration in hospitalised children. Relatively little is known about how staff use these systems.

Objective To examine the completeness and accuracy of PEWS recording in hospitalised children in a tertiary specialist children’s hospital.

Design This is a secondary analysis of retrospective, case-controlled study data. Case patients suffering from a critical deterioration event were matched with controls present on the same ward at the same time and matched for age. Data were extracted from the PEWS chart for the 48 hours before the critical deterioration event for case patients and the corresponding 48 hours period for the control. Observation sets were assessed for completeness and accuracy of PEWS scoring.

Results In total 297 case events in 224 patients were available for analysis. Overall 13 816 observations sets were performed, 8543 on cases and 5273 on controls. Only 4958 (35.9%) of observation sets contained a complete set of vital sign parameters and a concurrent PEWS. Errors were more prevalent in the observation sets of case patients versus controls (19.5% vs 14.1%). More errors resulted in the PEWS value being underscored rather than overscored for all observation sets (p<0.0001). 9.1% of inaccuracies for case patients were clinically significant, as the accurately calculated PEWS would have prompted a different escalation from the documented value.

Conclusion Failure to record complete and accurate PEWS may jeopardise recognition of children who are deteriorating. Technology may offer an effective solution.

  • resuscitation
  • intensive care
  • monitoring

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  • Contributors SMC conceived the initial idea for the study, collected and analysed the data, and wrote the initial manuscript draft. All authors contributed to study design and editing of the manuscript, and approved the final draft.

  • Funding This study received no direct funding but was supported by the National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Ethics approval The study was deemed to be a service evaluation initiative and exempt from ethics committee approval.

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

  • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • Presented at Data from this publication have previously been presented as part of the PhD programme of the lead author (, accessed 20 April 2019).

  • Patient consent for publication Not required.