Evaluation of data from the CCRT, suggests that the application of ICU expertise to patients before possible ICU admission may limit the value Belinostat ptcl of this threshold as for ICU admission, and that this level may be better viewed as a threshold for ICU consultation. Nearly 25% of the consultation episodes resulting in review within four hours were for patients with scores of 8 or more (Table (Table5).5). Conversely, 25% of the patients for whom the CCRT was urgently consulted, had scores of two or less (Table (Table4).4). We did not assess the appropriateness of consultation; however, it seems reasonable to suggest that many urgent requests for CCRT consultation may have been avoided with the prospective application of the Bedside PEWS score.LimitationsThere are several limitations to this study.

First, the results of his single-centre study may not generalise to other settings or populations. Prospective validation in different settings and with other patient populations is needed. Second, the clinical data contained many missing values. Ideally, complete data would have been prospectively obtained. To reduce the effect of missing data, we asked nurses to recall clinical data they observed but did not document, and we grouped data into one-hour blocks for score calculation. Despite this, prospective scoring of all seven items may have resulted in more complete data and higher scores than we found. The introduction of vital sign-based detection systems may increase documentation [24]. Third, the accuracy of data abstraction was not assessed, against either prospectively collected data, or by repeated assessment.

Fourth, we did not evaluate children for whom an immediate call for medical assistance to treat near or actual cardiopulmonary arrest was made. These children may be systematically different than patients who are recognised and admitted urgently to the ICU. Further validation in this and other populations is required before clinical application.ConclusionsWe describe the development and initial validation of the Bedside PEWS score. This seven-item score increased over the time leading up to urgent ICU admission, provided additional information to compliment retrospective nurse-rated of risk of sudden deterioration, and was higher in children who were subsequently admitted to the PICU than in ‘well’ control children.

Taken together, these data suggest that the Bedside PEWS can quantify severity of illness in hospitalised children. Following successful validation in other populations, clinical application of the Bedside PEWS may facilitate early identification of patients at risk, permitting timely intervention to prevent clinical deterioration, preventing unnecessary ICU admission and acquired morbidity to improve the outcomes of hospitalised children.Key messages? The Bedside PEWS Score is a simple, seven-item Batimastat severity of illness score for hospitalised children.