Pediatrics Book

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Pediatric Early Warning Score

Aka: Pediatric Early Warning Score, PEWS Score
  1. See Also
    1. Respiratory Distress in Children with Pneumonia
  2. Criteria
    1. Behavior
      1. Score 3
        1. Lethargic or
        2. Cofused or
        3. Reduced pain response
      2. Score 2
        1. Irritable or agitated and not consolable
      3. Score 1
        1. Sleeping or
        2. Irritable but consolable
      4. Score 0
        1. Playing or
        2. Appropriate activity for the patient
    2. Cardiovascular
      1. Score 3
        1. Grey appearance or
        2. Capillary Refill Time 5 seconds or longer or
        3. Tachycardia with Heart Rate 30 beats above normal for age
        4. Bradycardia for age
      2. Score 2
        1. Capillary Refill Time 4 seconds or less
        2. Tachycardia with Heart Rate 20 beats above normal for age
      3. Score 1
        1. Pale or
        2. Capillary Refill Time 3 seconds or less
      4. Score 0
        1. Skin Pink or
        2. Capillary Refill Time 1-2 seconds
    3. Respiratory
      1. Score 3
        1. Respiratory Rate 5 breaths per minute below normal range or
        2. Supplemental Oxygen of FIO2 50% or higher to maintain adequate oxygenation
      2. Score 2
        1. Respiratory Rate 20 breaths per minute above normal range or
        2. Accessory muscle use (neck retractions, intercostal retractions, abdominal breathing) or
        3. Supplemental Oxygen of FIO2 40-49% or 3 LPM or more to maintain adequate oxygenation
      3. Score 1
        1. Respiratory Rate 10 breaths per minute above normal range or
        2. Accessory muscle use (neck retractions, intercostal retractions, abdominal breathing) or
        3. Supplemental Oxygen of FIO2 24-40% or 2 LPM or more to maintain adequate oxygenation
      4. Score 0:
        1. Respiratory Rate normal for age
        2. No retractions
    4. Modifiers
      1. Score 2:
        1. Frequent interventions (e.g. frequent suctioning, repositioning, Supplemental Oxygen changes) or
        2. Multiple IV attempts
  3. Interpretation
    1. Calculate total score
      1. Add score from each category (behavior, cardiovascular, respiratory and modifier)
    2. Parental concern regardless of score
      1. Rapid response evaluation
    3. Total score 7 or more
      1. Assess every 30 minutes
    4. Total score 6
      1. Assess every 1 hour
    5. Total score 5
      1. Assess every 1-2 hours
    6. Total score 4 or less
      1. Assess every 4 hours
  4. References
    1. Duncan (2006) J Crit Care 21(3): 271-8 [PubMed]

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