Paediatric early warning systems (PEWS) in the ED.

In their EMJ publication, Coterrill et al 1 report on the ability of two paediatric early warning scores (PEWS): the Pennine Acute Trust Paediatric Observation Priority Score (PAT-POPS) and the Manchester Childrenu0027s Early Warning System (ManChEWS) to predict hospital admission for children presenting to their ED, with illnesses and injuries.While the ManChEWS system simply uses six physiological triggers in a binary fashion, the PAT-POPS system uses both aggregate-weighted, physiological responses and a list of specific medical conditions, which are scored and contribute to the final 18-point PAT-POPS score (eg, children who are ex-premature, diabetic, on long-term steroids, have a syndromic condition, have a metabolic disorder or an open access letter are given a ‘specific condition’ score of 1; children with congenital heart disease, asthma that prompted PICU admission or childhood cancer are given an additional score of 2).The PAT-POPS tool was statistically superior at predicting admission, although the authors question whether differences between the scoring systems were clinically significant, acknowledging that their study population was largely well (68% were ManChEWS ‘green’ while 62% scored ‘0/18’ on PAT-POPS).While PEWS use in medical conditions is widely accepted, their use in trauma is much less common. Nearly half (46%) of the patients studied …