The PAWS score: validation of an early warning scoring system for the initial assessment of children in the emergency department

Objective: To devise a physiology-based scoring system for assessment of children presenting to the emergency department (ED) and to validate the system retrospectively. Study design: Age-dependent physiological parameters designed to reflect the cardiovascular, respiratory and neurological status of patients presenting to the ED were included in a scoring system called the Paediatric Advanced Warning Score (PAWS). A retrospective pilot evaluation was performed to validate PAWS. Setting and patients: PAWS scores were calculated retrospectively for 46 consecutive children who required admission from the ED to the paediatric intensive care unit (PICU) and for 49 control children who were admitted from the ED to the general paediatric ward. Main outcome measures: To validate the PAWS score, we determined if this score was able to identify patients who require admission to the PICU and were therefore significantly unwell. Results: The PAWS score area under the receiver operating characteristic curve was 0.86. Using a trigger score of 3 or above, PAWS was able to identify patients requiring PICU admission with a sensitivity of 70% and a specificity of 90%. Conclusions: This pilot study has shown that a physiology-based scoring system can help to identify children in the ED requiring PICU admission. Future prospective validation of PAWS is necessary to assess its ability to identify all children in need of urgent assessment in the ED.