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OBJECTIVE Paediatric Early Warning Scores (PEWS) are widely used in the UK, but the heterogeneity across tools and the limited data on their predictive performance represent obstacles to improving best practice. The standardisation of practice through the proposed National PEWS will rely on robust validation. Therefore, we compared the performance of the National PEWS with six other PEWS currently used in NHS hospitals, for their ability to predict critical care (CC) admission in febrile children attending the emergency department (ED). DESIGN Retrospective single-centre cohort study. SETTING Tertiary hospital paediatric ED. PARTICIPANTS A total of 11 449 eligible febrile ED attendances were identified from the electronic patient record over a 2-year period. Seven PEWS scores were calculated (Alder Hey, Bedside, Bristol, National, Newcastle and Scotland PEWS, and the Paediatric Observation Priority Score, using the worst observations recorded during their ED stay. OUTCOMES The primary outcome was CC admission within 48 hours, the secondary outcomes were hospital length of stay (LOS) >48 hours and sepsis-related mortality. RESULTS Of 11 449 febrile children, 134 (1.2%) were admitted to CC within 48 hours of ED presentation, 606 (5.3%) had a hospital LOS >48 hours. 10 (0.09%) children died, 5 (0.04%) were sepsis-related. All seven PEWS demonstrated excellent discrimination for CC admission (range area under the receiver operating characteristic curves (AUC) 0.91-0.95) and sepsis-related mortality (range AUC 0.95-0.99), most demonstrated moderate discrimination for hospital LOS (range AUC 0.69-0.75). In CC admission threshold analyses, bedside PEWS (AUC 0.90; 95% CI 0.86 to 0.93) and National PEWS (AUC 0.90; 0.87-0.93) were the most discriminative, both at a threshold of ≥6. CONCLUSIONS Our results support the use of the proposed National PEWS in the paediatric ED for the recognition of suspected sepsis to improve outcomes, but further validation is required in other s

BACKGROUND AND AIM: In low-resource settings, a reliable bedside score to identify children at risk of dying could help focus resources and improve survival. The rapid bedside Liverpool quick sequential organ failure assessment (LqSOFA) uses clinical parameters only and performed well in the UK, but has not been validated in a low-resource setting. METHOD: In a cohort of critically ill children in Malawi, we calculated LqSOFA-scores using age-adjusted heart rate and respiratory rate, capillary refill time and Blantyre Coma Scale and evaluated its prognostic performance for mortality. An improved score, the Blantyre qSOFA (BqSOFA), was developed (omitting heart rate, adjusting respiratory rate cut-off values and adding pallor), subsequently validated in a second cohort of Malawian children, and compared with an existing more complex score (FEAST-PET). Prognostic performance for mortality was evaluated using area under the receiver operating characteristic curve (AUC). RESULTS: Mortality was 15.4% in the derivation (n=493) and 22.0% in the validation cohort (n=377). In the derivation cohort, discriminative ability (AUC) of the LqSOFA to predict mortality was 0.68 (95%-CI: 0.60-0.76). The BqSOFA and FEAST-PET yielded AUCs of 0.84 (95%-CI: 0.79-0.89) and 0.83 (95%-CI: 0.77-0.89) in the derivation cohort, and 0.74 (95%-CI: 0.68-0.79) and 0.76 (95%-CI: 0.70-0.82) in the validation cohort, respectively. CONCLUSIONS: We developed a simple prognostic score for Malawian children based on four clinical parameters which performed as well as more complex scores. The BqSOFA might be used to promptly identify critically ill children at risk of dying and prioritize hospital care in low-resource settings.