Is an emergency department early warning score effective?

July 27, 2020

Early warning scores have been shown to be helpful at determining children at risk of clinical deterioration. A report looks at whether an emergency department version of these scores could be effective.

Hospitals are using Pediatric Early Warning Scores (PEWSs) to detect children who could be at risk of clinical deterioration, but these scores were not meant to be used in an emergency setting. A new report in the Lancet Child & Adolescent Health reported on a specifically developed emergency department PEWS (ED-PEWS).1

Investigators used the TrIAGE project, which is a prospective observation study based on electronic health records between January 2012 and November 2015, that had data from 5 diverse EDs in the Netherlands, the United Kingdom, Austria, and Portugal. All consecutive ED visits of children aged younger than 16 years were included in the study’s data.

During the study period, 119,209 children were seen. Using the investigators’ reference standard, 2007 of the children were considered high urgency and 29,127 were intermediate urgency. They developed an ED-PEWS that included work of breathing, respiratory rate, oxygen saturation, consciousness, capillary refill time, heart rate, and age. In validation, the ED-PEWS had a cross-validated c-statistic of 0.86 for high-urgency patients and 0.67 in high-urgency or intermediate-urgency patients. When identifying high-urgency patients, a cutoff score of at least 15 was found to be useful in identifying high-urgency patients. In low-urgency patients, a cutoff score of less than 6 had a sensitivity of 0.83.

The researchers concluded that the ED-PEWS was helpful in identifying which children were high-urgency and which were low-urgency. The ED-PEWS also improved patient prioritization over current PEWSs.


1. Zachariasse JM, Nieboer D, Maconochie IK, et al. Development and validation of a paediatric early warning score for use in the emergency department: a multicentre study. Lancet Child Adolesc Health. 2020:4(8):583-591. doi:10.1016/s2352-4642(20)30139-5