EVALUATION OF THE BRIGHTON PEDIATRIC EARLY WARNING SCORE IN PREDICTING CLINICAL OUTCOMES OF PEDIATRIC PATIENTS ADMITTED TO THE EMERGENCY DEPARTMENT AT CHILDREN’S HOSPITAL 1
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Abstract
Background: Hospitalized children can experience rapid clinical deterioration if not identified early; however, many serious adverse events are preventable through timely detection via vital sign monitoring. While pediatric early warning systems - particularly the Brighton PEWS - have proven effective in clinical screening across various countries, local data remains limited. The Emergency Department at Children’s Hospital 1 receives a high volume of pediatric patients with diverse conditions and rapid disease progression, necessitating a simple, rapid, and reliable prognostic tool. Therefore, this study was conducted to evaluate the predictive value of the Brighton PEWS score for ICU admission at Children’s Hospital 1.
Objectives: To evaluate the predictive performance of the Brighton PEWS for admission to intensive care units (ICUs) among pediatric patients at the Emergency Department of Children’s Hospital 1.
Methods: A cross-sectional study was conducted on a sample of 250 pediatric patients admitted to the Emergency Department. from January 1, 2025, to July 31, 2025, at Children's Hospital 1.
Results: Among 250 enrolled patients, the 1 - 36 month age group predominated (51,6%), with a male-to-female ratio of 1,19:1. The most prevalent pathologies were respiratory (36,4%). The ICUs admission rate was 26,4%. Patients with a B-PEWS ≥ 4 had significantly higher ICUs admission rates than those with a B-PEWS ≤ 3 across all assessed time points (p < 0.05). At admission, the B-PEWS demonstrated fair predictive value for ICUs admission with an AUC of 0,743 (95% CI: 0,671–0,816, p<0.001) and an optimal cut-off of 4 (sensitivity 69,7%, specificity 67,9%). The scale’s predictive performance improved significantly at 2 hours and at the time of transfer, yielding AUCs of 0,846 (95% CI: 0,785 - 0,907, cut-off 3) and 0,901 (95% CI: 0,851 - 0,952, cut-off 2), respectively.
Conclusion: The Brighton Pediatric Early Warning Score (B-PEWS) is a simple, easy-to-implement tool with significant value in predicting the risk of admission to ICUs among pediatric patients in the Emergency Department, especially when applied through serial monitoring during the initial hours. Therefore, the implementation of B-PEWS should be considered for routine assessment in the Emergency Department, in conjunction with other clinical factors, to enhance prognostic accuracy.
Keywords
Brighton Pediatric Early Warning Score (B-PEWS), Emergency Department, Intensive care units.
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References
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