Science

The Bedside Paediatric Early Warning System – BedsidePEWS™ – was developed by Dr. Christopher Parshuram and Ms. Kristen Middaugh using expertise, statistical methods and vital signs data from patients admitted to The Hospital for Sick Children.  The BedsidePEWS score was subsequently validated in over 2000 patients from 4 hospitals, favourable local experiences and improved clinical outcomes have been reported in single centre studies.

Multicentre Validation
Number of Patients 2074
Number of University Affiliated Paediatric Hospitals 4
Number of clinical observations that make up the BedsidePEWS score 7
Specific paediatric age ranges 5
BedsidePEWS Score Range 0 to 26
Score Matched Care Recommendations (SMCR) 280 healthcare professionals

Research Showed the Following:

  • The BedsidePEWS score can identify children at risk of cardiac arrest with at least 1 hour notice
  • The BedsidePEWS score was superior at identifying children at risk of cardiac arrest than the retrospective opinion of the nurses
  • The score increases over time leading up to acute clinical events
  • BedsidePEWS scores are elevations and are apparent 12-24 hours before clinical events.
    • The scores are similarly elevated in patients with and without chronic diseases.
    • The scores can be easily and reliably calculated.

Currently BedsidePEWS™ is being used clinically in a CIHR-funded multi-national cluster randomized trial of the impact of BedsidePEWS™ on all-cause hospital mortality: EPOCH.

EPOCH Trial

Evaluating Processes of Care and Outcomes of Children in Hospital (EPOCH) is an 18-month, cluster-randomized trial study that is testing the effectiveness of the BedsidePEWS score in 22 hospitals around the world.

Our preliminary data shows that the BedsidePEWS score is superior to other methods being used to identify children at risk for impending cardiopulmonary arrest. The purpose of this study is to evaluate the BedsidePEWS on early identification of children at risk for near and actual cardiopulmonary arrest, hospital mortality, processes of care and PICU resource utilization.

The purpose of this study is to evaluate the impact of BedsidePEWS on early identification of children at risk for near and actual cardiopulmonary arrest, hospital mortality, processes of care and PICU resource utilization.

Eligibility Criteria for the EPOCH trial:

  • Hospitals that provide care for more than 200 inpatient admissions and have specialised paediatric physicians (including paediatricians, paediatric surgeons, other paediatric sub-specialists) and, one or more intensive care unit (PICU) that provides care for children.
  • Patients aged <18 years and >37 weeks gestational age in eligible inpatient wards each year

For more information on the EPOCH trial please visit here

Publications

Development and initial validation of the Bedside Paediatric Early Warning System score. Critical Care (August 2009). Christopher S. Parshuram, James Hutchison and Kristen Middaugh

In this study, we describe the dvelopment and initial validation of the BedsidePEWS™ score.

Conclusions: We developed and performed the initiaonl validation of the BedsidePEWS™ score. This 7-item score can quantify severity of illness in hospitalized children and identify critically ill children with at least one hours notice.

Multicentre validation of the bedside paediatric early warning system score: a severity of illness score to detect evolving critical illness in hospitalised children. Critical Care (August 2011). Parshuram et al.

The objective of this study was to validate the BedsidePEWS™ score in a large patient population at multiple hospitals.

Conclusions: Evaluation of clinical data from 2,074 patients in four paediatric hospitals showed that the BedsidePEWSTM score could identify children at risk of cardiac arrest with at least one hour’s notice. BedsidePEWS™ reflected evolving critical illness. Scores increased over the 24 hours before near or actual cardiopulmonary arrest events. The retrospective opinion of nurses caring for the patients studied was inferior to the BedsidePEWS™ score.

Download the BedsidePEWS study in PDF.

Implementing the Bedside Paediatric Early Warning System in a community hospital: A prospective observational study. Pediatrics and Child Health. (March 2011). Parshuram et al.

A prospective before and after study of the implementation of the BedsidePEWSTM score in a 22 bed regional pediatric center.

Conclusions: Results showed reduced stat calls to respiratory therapists and physicians (both ~4-fold reduction), reduced late transfers, and improved perceptions of documentation quality and inter-professional communication without significant change in resources or increase in workload.

Independent Reviews

Systematic review of paediatric alert criteria for identifying hospitalised children at risk of critical deterioration.Intensive Care Medicine (April 2010). Susan M. Chapman, Michael P.W. Grocott, Linda S. Franck

This study identifies the number and nature of published paediatric alert criteria and evaluate their validity, reliability, clinical effectiveness and clinical utility.

Conclusions: BedsidePEWS™ earlier paper-based version rated as 1 of 3 top systems of care.

 

 

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