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Peds-818:
Pediatric Early Warning Scores
TFQO: Ian Maconochie COI # 99
EVREVs: Alexis Topjian COI # 303
Taskforce: Antonio Rodriguez-Nunez COI # 14
COI Disclosure
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Alexis Topjian COI # 303
Antonio Rodriguez-Nunez COI # 14
Commercial/industry
• None
Potential intellectual conflicts
• None
2010 CoSTR
Topic not reviewed in 2010
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C2015 PICO
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Population: Infants and children in the inhospital setting
Intervention: Use of a Pediatric Early Warning
Score
Comparison: Not using a Pediatric Early Warning
Score
Outcomes: Overall hospital mortality (7-critical)
Cardiac arrest frequency outside the ICU (6important)
Inclusion/Exclusion
& Articles Found
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Inclusions/Exclusions
Inclusion: Observational retrospective or
prospective, RCT, Pediatrics, Early Warning Score
(of any type)
Exclusion: not related to the PICO question,
evaluations of Rapid Response Teams, Abstracts
Number of articles initially identified: 1741
RCT: 0
Non-RCT: 1
Excluded: 1740
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2015 Proposed
Treatment Recommendations
We suggest using a Pediatric Early Warning Score/
System for early detection of children at risk of respiratory
or cardiac arrest in the in-hospital setting
(weak recommendation, very low quality of evidence).
Risk of Bias in studies
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Evidence profile table(s)
Author(s): Alexis Topjian and Antonio Rodriguez-Nunez
Date: 2 November 2014
Question: Should PEWS vs. No PEWS be used in in-hospital pediatric patients?
Settings: Hospital mortality, Cardiac arrest outside ICU
Bibliography (systematic reviews): None.
№ of patients
Quality assessment
№ of
studies
Study
design
Risk of
bias
Inconsistency
Indirectness
Impreci
sion
Not serious
serious
serious
Effect
Relative
(95% CI)
Absolu
te
(95%
CI)
Quality
PEWS
No
PEWS
publication bias
strongly suspected
all plausible residual
confounding would
reduce the
demonstrated effect 1
None
Specified
None
Specified
not
estimabl
e
not
estima
ble
⨁◯
◯◯
publication bias
strongly suspected
all plausible residual
confounding would
reduce the
demonstrated effect 1
None
Specified
Other considerations
Importanc
e
CARDIAC ARREST
1
Randhawa
, 2011
observational
studies
serious
3
3
1
CRITICAL
VERY LOW
MORTALITY AFTER CARDIAC ARREST
1
Randhawa
, 2011
observational
study
very
serious
Not serious
2
serious
2
serious
2
None
Specified
not
estimabl
e
not
estima
ble
⨁◯
◯◯V
ERY LOW
CRITICAL
Proposed
Consensus on Science
statements
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For the critical outcome of incidence of cardiac arrest, we
have identified evidence from one very low quality pediatric
observational study (downgraded for risk of bias,
indirectness, imprecision and possible publication bias)
describing improved outcome with the use of PEWS in a
hospital (Randhawa, 2011, 443)
For the critical outcome of reduced mortality from cardiac
arrest, we have identified no evidence that showed changes
in cardiac arrest rate or mortality outside of the PICU setting.
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Draft
Treatment Recommendations
We suggest using a Pediatric Early Warning Score/
System for early detection of children at risk of respiratory
or cardiac arrest in the in-hospital setting
(weak recommendation, very low quality of evidence).
Knowledge Gaps
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If PEWS independent of intervention have an
impact on outcomes
Specific research required
Prospective research evaluating PEWS
Evaluating efficacy of different PEWS
Next Steps
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