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Paediatric Early Warning Systems in 2019: What We Know and What We’ve Yet to Learn

  • Patient Safety (M Scanlon, Section Editors)
  • Published:
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Abstract

Purpose of review

Paediatric Early Warning Systems (PEWS) are used extensively in hospitals around the world in an attempt to recognise and respond to children who are at risk of harm from deterioration. Most systems are based on the ability of physiological measurements to predict future events. Evidence supporting their use however is limited especially for important measures such as death. This review seeks to examine history and experience of PEWS and to explore recent literature for ideas that would enhance existing PEWS and new concepts that might complement the goal of recognising and responding to deterioration in hospital.

Recent findings

The largest study of PEWS, the EPOCH trial published in 2018, did not demonstrate a benefit in reducing mortality or other key indicators, from the use of the Canadian Bedside PEWS. There were several flaws that raise questions about the validity of the study; however, it also raises important issues for discussion. There have been recent studies published that propose alternative approaches to identifying deterioration including improved situation awareness and better teamwork.

Summary

We propose that it is possible to recognise and respond to early signs of deterioration in a way that reduces important outcomes; however, this will require blended approaches that embrace the complexity of the task.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Children’s Health Ireland @ Children’s University Hospital, Temple St, Dublin 1, Ireland

    John Fitzsimons MB, BCh, BAO, MSc, DipLQH, MRCPI, FRCPCH & Michaela Pentony MB, BCh, BAO, MRCPI

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  1. John Fitzsimons MB, BCh, BAO, MSc, DipLQH, MRCPI, FRCPCH
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  2. Michaela Pentony MB, BCh, BAO, MRCPI
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Correspondence to John Fitzsimons MB, BCh, BAO, MSc, DipLQH, MRCPI, FRCPCH.

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John Fitzsimons declares that he has no conflict of interest. Michaela Pentony declares that she has no conflict of interest.

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Fitzsimons, J., Pentony, M. Paediatric Early Warning Systems in 2019: What We Know and What We’ve Yet to Learn. Curr Treat Options Peds 5, 315–325 (2019). https://doi.org/10.1007/s40746-019-00176-1

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