Validation of the Pediatric Early Warning Score to determine patient deterioration from illness

Main Article Content

Lenny Elita
Silvia Triratna
Erial Bahar


Background Patients who enter the emergency room (ERER) present with a variety of conditions, ranging from mild to critical. As such, it may be hard to determine which patients are in need of intensive care unit treatment. The Pediatric Early Warning Score (PEWS) has been used to identify signs of critical illness in pediatric patients.

Objective To validate the PEWS system for assessing signs of critical illness in pediatric patients at Dr. Mohammad Hoesin Hospital, Palembang.

Methods Subjects were children aged 1 month to 18 years who received treatment in the ERER and Pediatrics Ward in

Dr. Mohammad Hoesin Hospital in March to April 2015. Assessment with PEWS was based on vital sign examinations. Scores ranged from 0 to 9. The PEWS was generally taken twice, first in the ER , then after 6 hours in the ward. We obtained the cut-off point, sensitivity, and specificity of PEWS, in terms of need for pediatric intensive care unit (PICU) treatment.
Results One hundred fifty patients were included in this study. Patients with PEW score of 5 or greater in the ER were relatively more likely to be transferred to the PICU, with a sensitivity of 94.4% and a specificity of 82.5%. The cut-off point obtained from the ROC curve was score 4.5 with AUC 96.7% (95%CI 93.4 to 99.9%; P<0.001).

Conclusion A PEWS score of cut-off ≥5 may be used to determine which patients are in critically ill condition requiring treatment in PICU.

Article Details

How to Cite
Elita L, Triratna S, Bahar E. Validation of the Pediatric Early Warning Score to determine patient deterioration from illness. PI [Internet]. 31Aug.2016 [cited 16Sep.2019];56(4):251-. Available from:
Received 2016-10-03
Accepted 2016-10-03
Published 2016-08-31


1. Akre M, Finkelstein M, Erickson M, Liu M, Vanderbilt L, Billman G. Sensitivity of pediatric early warning score to identify patient deterioration. Pediatrics. 2010;125:763-9.
2. Kementerian Kesehatan Republik Indonesia. Standar instalasi gawat darurat (IGD) rumah sakit. Jakarta: Kementerian Kesehatan Republik Indonesia; 2009. p. 1-3.
3. Latief A, Pudjiadi A, Chair I. Menyongsong masa depan. In: Pudjiadi A, Latief A, Budiwardhana N, editors. Pediatrik gawat darurat. Jakarta: Ikatan Dokter Anak Indonesia; 2013. p. 1-7.
4. Dieckmann RA, Brownstein D, Gausche-Hill M. The pediatric assessment triangle: a novel approach for the rapid evaluation of children. Pediatr Emerg Care. 2010;26:312-5.
5. Farrohknia N, Castren M, Ehrenberg A, Lind L, Oredsson S, Jonsson H, et al. Emergency department triage scales and their components: a systematic review of the scientific evidence. Scand J Trauma Resusc Emerg Med. 2011;19:42.
6. M Monaghan A. The Brighton pediatric early warning score. Brighton and Sussex University Hospital [slide presentation on the internet]. c 2005 [cited 2015 May 15]. Available from:
7. Monaghan A. Detecting and managing deterioration in children. Paediatr Nurs. 2005;17:32-5.
8. Bradman K, Maconochie I. Can paediatric early warning score be used as a triage tool in paediatric accident and emergency? Eur. J. Emerg. Med. 2008;15:359-60.
9. Wahyudi P. Gambaran skor Pediatric Early Warning Score (PEWS) pada pola rujukan pasien anak di instalasi gawat darurat RSUD Arifin Achmad Pekanbaru. JOM PSIK. 2014;1:1-8.
10. Frankel L. Respiratory distress and failure. In: Kliegman R, Behrman R, Jenson H. Nelson textbook of pediatrics. 18th ed. Philadelphia: Saunders Elsevier; 2007. p. 59-62.
11. Padlijiadi S, Gausche. Respiratory distress and respiratory failure. In: Fleisher G, Ludwig S. Pediatric emergency medicine. Philadelphia: LWW; 2008. p. 13-26.
12. Van Veen M, Moll HA. Reliability and validity of triage systems in paediatric emergency care. Scand J Trauma Resusc Emerg Med. 2009;29:1-8.
13. Yu KT, Green RA. Critical aspects of emergency department documentation and communication. Emerg Med Clin North Am. 2009;27:641-54.
14. Skaletzky SM, Raszynski A, Totapally BR. Validation of a modified pediatric early warning system score: a retrospective case-control study. Clin Pediatr. 2012;51:431–5.
15. Solevag AL, Eggen EH, Schroder J, Nakstad B. Use of a modified pediatric early warning score in a department of pediatric and adolescent medicine. PLoS One. 2013;8:e72534.