Objective: To review the available evidence on effectiveness of the pediatric early warning score (PEWS) in predicting clinical deterioration in children in healthcare settings. Materials and methods: The electronic databases like PubMed, Google Scholar, etc., were searched up to December 2018, systemically using keywords including early warning scoring system, rapid response, pediatric, and severity of illness. Studies included should have used PEWS for assessing the severity in children in bedside, emergency, and oncology settings. The outcome had to identify the clinical deterioration in children and shifting to PICU/activation of the rapid response team. Results were normatively synthesized. Results: On total screening of 1,254 papers, 52 papers met the criteria and 10 papers were included to write the review article as it met the inclusion criteria. It revealed that PEWS is used extensively in varied settings. But still PEWS had limited use because of variation of scores according to settings. Positive outcomes were identification of sick children and intervention with multidisciplinary team work and effective communication and confidence in treating children. Conclusion:Despite many studies reporting the usefulness of PEWS, no evidence was available for which PEWS to be used. Further research on PEWS is needed for assessing the impact of PEWS implementation and outcome in resource-limited settings.
Pediatric early warning score is a standardized score assigned to a patient through assessment of various physiological, behavioral, and clinical parameters. These warning systems facilitate early detection of clinical deterioration. These scores have proven to improve multidisciplinary team work, communication, and confidence in recognizing, reporting, and making decisions about a child at risk of clinical deterioration [1,2]. Different pediatric early warning scores (PEWSs) were developed, modified, and validated in various places across the globe, with majority of contributions from developed countries [3][4][5][6][7][8][9][10][11]. There is a wide heterogeneity in PEWS used with regard to the number of parameters settings where they are applied and the outcomes measured. However, not all of them could be applied in resource restricted settings because of the need for special equipment and technical expertise. Brighton PEWS tool is a simple clinical score involving three parameters, which can be easily performed even by nurses without the need for special equipment [6].Most of the studies have implemented Brighton PEWS in pediatric inpatient units [6,7]. There is a paucity of literature regarding the implementation of PEWS in pediatric ED; especially, in the Indian population. In resource-limited settings where specialists may not be available, registered medical practitioners or nursing personnel may be the first personnel to encounter pediatric patients. Availability of simple and validated clinical tool becomes crucial to identify the children at risk of deterioration in such settings. Hence, this study was designed to assess the validity of Brighton's PEWS tool in predicting clinical deterioration in children admitted from emergency departments (EDs) and to assess the interobserver agreement between nurses administered PEWS and pediatric trainee administered PEWS.
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