Aims Across the UK there is diverse practise in the use of Paediatric Early Warning Scores (PEWS). Many scoring systems are in use and include different physiological parameters to identify children at risk of life-threatening deterioration. Unlike adult practise, PEWS often comprise of both objective and subjective criteria. ‘Effort of breathing’ is a subjective parameter commonly included in paediatric scoring systems. Determining a child’s effort of breathing is influenced by factors including appropriate exposure of the patient as well as clinical skill, experience and acumen of the scorer.
As part of a study assessing the validity of PEWS charts, a large data set was collected. Analysis of the NHS Institute PEWS chart is made here.
Method Physiological parameters were collected retrospectively from a cohort of 1537 children aged 0–16 years attending a district general hospital’s Children’s Emergency Department over a 5 week period. Admission to Paediatric High Dependency or Intensive Care were used as proxy outcome measures for serious and life-threatening deterioration.
Results Data was complete for 967 records. At a best cut-off score of 3, NHS Institute PEWS had a sensitivity of 64.3% (95% CI 35.6–86.0), specificity of 96.5% (95% CI 95.1–97.6), positive predictive value of 21.4% (95% CI 10.8–37.2) and negative predictive value of 99.5% (95% CI 98.7–99.8). The area under the Receiver Operating Characteristic curve (AUC) (figure 1) was 0.86 (95% CI 0.74–0.98, p < 0.01). If ‘effort of breathing’ was excluded from NHS Institute PEWS the AUC was 0.85 (95% CI 0.74–0.97, p < 0.00).
Conclusion The NHS Institute PEWS is a valid tool with good diagnostic accuracy in recognising children at risk of serious and life-threatening deterioration at triage in the Emergency Department. The predictive power did not change when ‘effort of breathing’ was excluded. It is reassuring that such a subjective parameter does not undermine the value of the scoring system. However, further work is needed to determine whether other subjective measures have any value in paediatric early warning tools.
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