LAUSR

Paediatric Early Warning Systems (PEWS) are used extensively in hospitals around the world in an attempt to recognise and respond to children who are at risk of harm from deterioration. Most systems are based on the ability of physiological measurements to predict future events. Evidence supporting their use however is limited especially for important measures such as death. This review seeks to examine history and experience of PEWS and to explore recent literature for ideas that would enhance existing PEWS and new concepts that might complement the goal of recognising and responding to deterioration in hospital. The largest study of PEWS, the EPOCH trial published in 2018, did not demonstrate a benefit in reducing mortality or other key indicators, from the use of the Canadian Bedside PEWS. There were several flaws that raise questions about the validity of the study; however, it also raises important issues for discussion. There have been recent studies published that propose alternative approaches to identifying deterioration including improved situation awareness and better teamwork. We propose that it is possible to recognise and respond to early signs of deterioration in a way that reduces important outcomes; however, this will require blended approaches that embrace the complexity of the task.