PEWS — Paediatric Early Warning Score Nigeria · Kenya · Ghana
Age-adjusted vital sign scoring with colour-coded risk band and escalation protocol.
Respiratory, cardiovascular, and neurological domains. Frequency-of-monitoring guidance.
Brighton PEWS · RCPCH 2023 · WHO Pocket Book 2013. Offline-capable.
For qualified healthcare professionals only.
PEWS is a screening tool to identify deteriorating children early — it is not a diagnostic tool. A high PEWS requires immediate clinical assessment, not just a response algorithm. Trust clinical judgement alongside the score.
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Clinically reviewed by
Dr. Chioma Okafor, FWACP (Paeds)
Consultant Paediatrician, University of Nigeria Teaching Hospital
Updated 2025-09-01
Step 1 — Country
Step 2 — Age Band
Infant (0–12m): Normal RR 30–60, HR 100–160. Vital sign thresholds adjust per age band.
Failure to recognise and escalate deteriorating hospitalised children is a leading cause of preventable paediatric cardiac arrest and in-hospital death in both high- and low-income settings. The Paediatric Early Warning Score (PEWS) provides a structured, reproducible system that enables nurses and junior doctors to trigger senior clinical review before deterioration becomes irreversible. PEWS has been prospectively validated in multiple African settings including Uganda, Kenya and South Africa, demonstrating sensitivity of over 85% for identifying children who deteriorate within 24 hours. The WHO Pocket Book of Hospital Care for Children recommends PEWS-based escalation for all paediatric inpatients in resource-limited settings.
References & Guidelines
Monaghan A. Detecting and managing deterioration in children. Paediatr Nurs. 2005;17(1):32–35.
PEWS ≥3: immediate bedside clinical review by a senior nurse or doctor. PEWS ≥5: urgent senior medical review required within 30 minutes — consider high-dependency monitoring. PEWS ≥7: immediate critical care escalation. Lower thresholds may apply in neonates or post-operative patients — follow your institution's PEWS escalation protocol.
PEWS scores three clinical domains: (1) Behaviour — from alert/playing (0) to unresponsive/reduced pain response (3); (2) Cardiovascular — heart rate, capillary refill time, skin colour scored 0–3; (3) Respiratory — respiratory rate, respiratory effort, and oxygen requirement scored 0–3. Total score 0–9; higher = greater risk.
Stable patients (PEWS 0–1): every 4–6 hours. PEWS 2: every 2 hours. PEWS 3–4: every 1 hour with senior nurse review. PEWS ≥5: continuous monitoring or every 30 minutes with medical review. Document PEWS on every set of observations and escalate as per your hospital protocol without delay.
PEWS tools were developed primarily in high-income countries and have variable validation data for sub-Saharan African hospitals. Key limitations: oxygen saturation monitoring may be unavailable at all PEWS assessment points; nursing ratios affect frequency and quality of observations; some trigger thresholds may not translate to African paediatric populations with higher baseline physiological variation. Despite these limitations, structured early warning systems consistently reduce preventable cardiac arrest in hospitalised children compared to unstructured observation, making PEWS valuable even in resource-constrained settings.
Multiple validated versions of PEWS exist — the Brighton PEWS (Monaghan 2005), the Bedside PEWS (Parshuram 2011), and the NICE NG119 modified PEWS differ in their parameters and trigger thresholds. This calculator uses a simplified, pragmatic version adapted for Nigerian district hospital settings based on the core domains (cardiovascular, respiratory, neurological) identified by RCPCH. The exact version and threshold used at any institution should be agreed and standardised locally. Mixed use of different PEWS versions within one facility increases error risk.