Table 1

Comparisons of the Melbourne Activation Criteria (MAC)* with Cardiff and Vale Paediatric Early Warning System (C&VPEWS)†

MAC indicatorsC&VPEWS indicatorsComparison MAC and C&VPEWS
1. Nurse or doctor worried about clinical state8. Nurse or doctor worried about clinical stateIdentical indicators
2. Airway threat1. Airway threat, for example, stridorIdentical indicators
3. Hypoxaemia:
  • SpO2 < 90% in any amount of oxygen

  • SpO2 < 60% in any amount of oxygen (cyanotic heart disease)

2. Child requiring any amount of oxygen to keep saturations greater than 90%Indicators different. For the purpose of this study the MAC was positive if SpO2 < 90% in air or any amount of oxygen
4. Severe respiratory distress, apnoea or cyanosis4. Abnormal respiratory observations, that is, recession or accessory muscle usedIndicators different. For the purpose of this study the MAC was positive if there were signs of respiratory distress as per the Advanced Paediatric Life Support guidelines
5. Tachypnoea3. Respiratory rate (outside normal range)Identical indicators. Different ranges were used in the two systems. Respiratory rate was recorded so MAC was precisely determined
6. Tachycardia or bradycardia5. Bradycardia or tachycardiaIdentical indicators. Different ranges were used in the two systems. Heart rate was recorded so MAC was precisely determined
7. Hypotension6. Blood pressure (outside normal range)Identical indicators. Different ranges were used in the two systems. Systolic blood pressure was recorded so MAC was precisely determined
8. Acute change in neurological state or convulsion7. Level of consciousness (abnormal if only responding to voice or less)Indicators different. For the purpose of this study the MAC was positive if the conscious level was reduced
9. Cardiac or respiratory arrestNot an indicatorCardiac or respiratory arrest was used as an outcome measure in the original C&VPEWS. The data were therefore available to determine the MAC
  • Note: Indicators are numbered in columns 1 and 2 as described in the original papers from which they are adapted

  • * Adapted from Tibballs J et al.6

  • Adapted from Edwards et al.5