Our group previously developed a 16-item severity of illness score for use in hospitalised children [4]. It had favourable performance characteristics; however, its complexity was felt to limit clinical application [10]. then The objective of this study was to create a simple score for routine bedside use. The purpose of this score was to quantify severity of illness across in hospitalised children. We wanted the score properties of the new score to include a range of scores between ‘sick’ and ‘well’ patients to permit the future development of score-matched care recommendations. We called this new score the Bedside Paediatric Early Warning System (PEWS) score.Materials and methodsThe Bedside PEWS score was developed and initial validation was performed.

The goal of score development was to create a simple severity of illness score that could discriminate between sick and less sick children for use as part of routine care. Validation of the Bedside PEWS score involved evaluations comparing the score versus expert opinion, progression of the score over time, and the scores and outcomes of children referred to, or followed by a Paediatric Medical Emergency Team, called the Critical Care Response Team (CCRT).Clinical dataStudy data were obtained from three sources: patients in a case-control study, a survey of nurses caring for the patients in the case-control study, and prospectively collected data from patients seen by the CCRT.Eligible patients for the case-control study were admitted to a hospital ward at the Hospital for Sick Children, had no limitations to their care and were less than 18 years of age.

‘Case’ patients were admitted urgently to the paediatric intensive care unit (PICU) from a hospital inpatient ward following urgent consultation with the PICU, but not following a call for immediate medical assistance (a ‘code-blue’ call). ‘Control’ patients were admitted to an inpatient ward (not the PICU, neonatal ICU, an outpatient area or the emergency department) during the period of study, and in the 48 hours following inclusion did not have a ‘code-blue’ call and were not urgently admitted to the PICU. Case patients were identified by prospective daily screening of PICU admissions; control patients were frequency matched with each case patient on the basis of age group, and the type of ward. Two control patients were recruited for each case patient.

Clinical data were abstracted directly from the medical record and was supplemented by interview with consenting frontline nursing staff. Data was collected for 12 hours in control patients, and for 24 hours ending at the time of urgent PICU admission in case patients. The study nurses recorded the clinical data that was documented and that which Carfilzomib was not documented but was known by the frontline nurses. They did not calculate candidate scores or sub-scores.