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Paediatric early warning systems (PEWS) in the ED
  1. Julian M Sandell1,
  2. Ian K Maconochie2
  1. 1Department of Child Health, Poole Hospital NHS Foundation Trust, Poole, UK
  2. 2Department of Accident & Emergency, Queen Elizabeth the Queen Mother Wing, Imperial College School of Medicine, St. Mary's Hospital, London, UK
  1. Correspondence to Dr Julian M Sandell, Consultant in Paediatric Emergency Medicine. Department of Child Health. Poole Hospital NHS Foundation Trust. Longfleet Road, Poole, Dorset, BH15 2JB, UK; julian.sandell{at}

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In their EMJ publication, Coterrill et al1 report on the ability of two paediatric early warning scores (PEWS): the Pennine Acute Trust Paediatric Observation Priority Score (PAT-POPS) and the Manchester Children's 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 …

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  • Contributors JMS and IKM equally wrote and co-authored this editorial.

  • Competing interests JMS adapted and designed the Children's Observation And Severity Tool (COAST) chart, with permission, from the original NHS Institute for Innovation & Improvement's PEWS chart, in 2010. IKM is in receipt of a grant from National Institute for Health Research Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London.

  • Provenance and peer review Commissioned; internally peer reviewed.

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