The Cardiff and Vale Paediatric Early Warning System (C&V PEWS) can be used to identify a pediatric patient in the hospital who may require an immediate response and more aggressive management.
Abnormal criteria:
(1) threat to the airway (stridor, etc)
(2) abnormal respiratory observations (recession or use of accessory muscles)
(3) respiratory rate outside of the normal range for age(hypopnea or tachypnea, see below)
(4) need for supplemental oxygen to keep the oxygen saturation > 90%
(5) heart rate outside of the normal range for age (bradycardia or tachycardia, see below)
(6) blood pressure outside of the normal range (hypotension or hypertension, see below)
(7) abnormal level of consciousness (responds to voice, pain or unresponsive)
(8) health care provider worried about the patient’s clinical state
|
Age |
Lower End to Normal Range for Respirations |
Upper End to Normal Range for Respirations |
|
< 1 year |
20 |
50 |
|
1 to 2 |
15 |
45 |
|
2.01 to 5 |
15 |
40 |
|
5.01 to 12 |
10 |
35 |
|
> 12 |
10 |
30 |
|
Age |
Lower End to Normal Range for Heart Rate |
Upper End to Normal Range for Heart Rate |
|
< 1 year |
90 |
160 |
|
1 to 2 |
80 |
150 |
|
2.01 to 5 |
75 |
140 |
|
5.01 to 12 |
60 |
120 |
|
> 12 |
55 |
100 |
|
Age |
Lower End to Normal Range for Systolic Blood Pressure |
Upper End to Normal Range for Systolic Blood Pressure |
|
< 1 year |
70 |
90 |
|
1 to 2 |
80 |
95 |
|
2.01 to 5 |
80 |
100 |
|
5.01 to 12 |
90 |
110 |
|
> 12 |
100 |
120 |
number of abnormal findings =
= SUM(number of abnormal criteria found)
Interpretation:
• minimum number of abnormal findings: 0
• maximum number of abnormal findings: 8
• The optimum cutoff is >=2 with a sensitivity of 70% and specificity of 90%.
• A cutoff of >= 3 was 98% specific but only 48% sensitive.
• A cutoff >= 1 had a sensitivity of 90% and specificity of 64%. This might not be sufficient to trigger a call to the rapid response team but should trigger closer monitoring.
Limitation:
• There is no weighting for extent of deviation from normal.
Purpose: To identify a pediatric patient in the hospital who may require a rapid response evaluation based on the Cardiff and Vale Pediatric early warning system (PEWS).
Objective: differential diagnosis and mimics, red flags, failure handling, when to refer
ICD-10: ,
