Pediatric Early Warning Score (PEWS)

Evaluates health and status deterioration risk in infant and child patients.

In the text below the calculator, there is more information on how to interpret the results and on the care recommendations.

The pediatric early warning score (PEWS), is the adapted version of the NEWS which is the similar health evaluation score for adults.

It evaluates infant and children health status based on cardiovascular, respiratory and output signs, along with behaviour.

Receiving information about the risk of deterioration of the child’s condition, medical personnel can adapt accordingly the level of care offered.

There are two alternative score classifications, one that provides recommendations in regard to the need for a medical specialist and another that recommends monitoring frequency:

■ Code green (0-3): no immediate action but monitoring;

■ Code amber (4-6): specific hierarchical medical professional should see the patient as soon as possible;

■ Code red (7-12): the patient should be seen as a matter of urgency immediately.

Score interpretation based on monitoring frequency:

■ Scores less than 4: evaluation every 4 hours;

■ Scores of 5: assessment every 1-2 hours;

■ Scores of 6: hourly evaluation;

■ Scores of 7 to 12: half hourly evaluation.









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PEWS explained

The pediatric early warning score consists of 4 items which are used in ER pediatric evaluations to check the health status of the patient and offer information on need for immediate care or subsequent evaluations.

The following table introduces the score items and their answer choices:

PEWS item Answer choices (points)
Behavior Playing or sleeping comfortably (0)
Irritable and consolable (1)
Irritable and not consolable (2)
Lethargic, confused or reduced response to pain (3)
Cardiovascular Pink or capillary refill time <1-2 seconds (0)
Pale or capillary refill time 3 seconds (1)
Grey or capillary refill time 4 seconds (2)
Heart rate 20 above or below normal rate (2)
Grey and mottled or capillary refill time >4 seconds (3)
Heart rate 30 above or below normal heart rate (3)
Respiratory Within normal rate, no retractions and S pO2 98-100% on RA (0)
RR >10 above normal limits or S pO2 98-100% on any O2 device (1)
S pO2 94-97% on RA OR using accessory muscles (1)
RR >20 above normal limits or S pO2 90-93% or retractions (2)
RR 5 or below normal or S pO2 <90% or retractions and grunting (3)
Output Reaching target urine output goal of 0.5-1mL/kg/h and 0-1 BMs/emesis events in the last 12h (0)
2 BMs/emesis events in the last 12h (1)
3 BMs/emesis events in the last 12h (2)
<0.5 mL/kg/h output or >3 BMs/emesis in the last 12h (3)

The behavior item examines the appearance and actions of the child, the cardiovascular item observes teguments and capillary refill time as well as pulse.

The respiratory item checks the oxygen saturation and the breathing rate and can be used to assess respiratory distress in children with pneumonia presentation, whilst the output item evaluates urine output.

The items are similar to those in other ER clinical decision making tools, such as the pediatric Glasgow Coma Scale.

The PEWS is used to stratify risk in order to ensure pediatric patients are viewed in the order of their status gravity, similarly to how the national and modified early warning scores, NEWS and MEWS do in the case of adult patients.


Score interpretation

In order to increase the efficiency of emergency room response, one of the score interpretations classifies patients under codes and provides recommendations as to when the patient should be seen by a medical specialist:

Code PEWS score Interpretation
Green 0 - 3 No action is immediately required but the patient should continue to be monitored and the status reassessed accordingly.
However, if the score is 3 and consists of one answer of 3 points in any item, the specific hierarchical medical professional needs to be notified and evaluate the patient right away.
Amber 4 - 6 The specific hierarchical medical professional should be notified and the patient should be seen by them as soon as possible.
Red 7 - 12 The patient should be seen by the specific hierarchical medical professional as a matter of urgency immediately.

Another version of score interpretation offers recommendations as to when reassessment should occur:

■ Scores less than 4 – indicate assessment every 4 hours;

■ Scores of 5 – require evaluation every 1-2 hours;

■ Scores of 6 – indicate hourly evaluation;

■ Scores of 7 to 12 – indicate half hourly evaluation.


About the study

PEWS was developed by a multidisciplinary group at Brighton and Sussex University Hospitals NHS Trust in the UK.

It was aimed at increasing efficiency during triage and a faster identification of pediatric patients at risk for clinical deterioration.

Most of the studies that have validated the score have shown a high sensitivity in identifying patient deterioration.

For example, the one conducted by Duncan et al. found 78% sensitivity and 95% specificity at a score of 5.


Original source

Monaghan A. Detecting and managing deterioration in children. Paediatr Nurs. 2005; 17(1):32-5.

Other references

1. Duncan H, Hutchison J, Parshuram CS. The Pediatric Early Warning System score: a severity of illness score to predict urgent medical need in hospitalized children. J Crit Care. 2006; 21(3):271-8.

2. Akre M, Finkelstein M, Erickson M, Liu M, Vanderbilt L, Billman G. Sensitivity of the pediatric early warning score to identify patient deterioration. Pediatrics. 2010; 125(4):e763-9.

3. Gold DL, Mihalov LK, Cohen DM. Evaluating the Pediatric Early Warning Score (PEWS) System for Admitted Patients in the Pediatric Emergency Department. Acad Emerg Med. 2014; 21(11): 1249–1256.

Specialty: Pediatrics

Objective: Evaluation

Type: Score

No. Of Items: 4

Year Of Study: 2005

Abbreviation: PEWS

Article By: Denise Nedea

Published On: April 18, 2017

Last Checked: April 18, 2017

Next Review: April 18, 2023