McLellan et al reported the Children's Hospital Early Warning System (CHEWS) for evaluating a hospitalized, non-cardiac pediatric patient. It is based on modifications of the Brighton PEWS. The authors are from Boston Children's Hospital and Harvard Medical School in Boston.
Parts:
(1) behavioral and neurologic: behavior, seizures, pupillary reaction
(2) cardiovascular: skintone, capillary refill, tachycardia, arrhythmia, bradycardia
(3) respiratory: breathing rate, supplemental oxygen, oxygen by nasal cannula, oxygen saturation, apnea
(4) staff concern
(5) family concern
|
Grading Tachycardia or Tachypnea |
Infant |
Toddler or Child |
|
mild |
10 to 14.9% increase |
10 to 24.9% |
|
moderate |
15 to 24.9% increase |
25 to 49.9% increase |
|
severe |
>= 25% increase |
>= 50% increase |
|
Parameter |
Finding |
Points |
|
behavior |
alert, playing, sleeping appropriately |
0 |
|
|
sleepy, somnolent when not disturbed |
1 |
|
|
irritable, difficult to console |
2 |
|
|
lethargic, confused, floppy, reduced response to pain |
3 |
|
seizures |
none or not increased |
0 |
|
|
increased |
2 |
|
|
prolonged or frequent |
3 |
|
pupillary reaction |
normal |
0 |
|
|
asymmetric or sluggish |
3 |
subscore for behavioral and neurologic factors =
= MAX(points for all of the behavioral and neurologic parameters)
|
Parameter |
Finding |
Points |
|
skin tone |
appropriate for patient |
0 |
|
|
pale |
1 |
|
|
grey |
2 |
|
|
grey and mottled |
3 |
|
capillary refill |
<= 2 seconds |
0 |
|
|
3-4 seconds |
1 |
|
|
4-5 seconds |
2 |
|
|
> 5 seconds |
3 |
|
tachycardia |
none |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
arrhythmias |
none |
0 |
|
|
existing intermittent ectopy or irregular rate |
1 |
|
|
new onset or increase in ectopy, irregular rate or heart block |
3 |
|
bradycardia |
none |
0 |
|
|
existing |
1 |
|
|
new onset |
3 |
subscore for cardiovascular factors =
= MAX(points for all of the cardiovascular parameters)
|
Parameter |
Finding |
Points |
|
breathing rate |
normal with no retractions |
0 |
|
|
mild tachypnea |
1 |
|
|
moderate tachypnea with increased work of breathing |
2 |
|
|
severe tachypnea |
3 |
|
|
lower than normal |
3 |
|
supplemental oxygen |
none |
0 |
|
|
up to 40% |
1 |
|
|
40-60% |
2 |
|
|
> 60% |
3 |
|
oxygen flow by nasal cannula |
none |
0 |
|
|
up to 1 liter |
1 |
|
|
1-2 liter |
2 |
|
|
> 2 liters |
3 |
|
oxygen saturation |
normal or stable |
0 |
|
|
mild desaturation from baseline (< 5) |
1 |
|
|
moderate desaturation from baseline (5 to 9.9) |
2 |
|
|
severe desaturation (> 10) |
3 |
|
apnea |
none |
0 |
|
|
intermittent |
1 |
|
|
requiring repositioning or stimulation |
2 |
|
|
requiring a significant intervention |
3 |
subscore for respiratory factors =
= MAX(points for all of the respiratory parameters)
|
Parameter |
Finding |
Points |
|
staff concern |
no |
0 |
|
|
yes |
1 |
|
family concern |
no |
0 |
|
|
yes |
1 |
subscore for concerns =
= SUM(points for both parameters)
CHEWS =
= SUM(all of the subscores)
Interpretation:
• minimum score: 0
• maximum score: 11
|
Score |
Color Code |
Response |
|
0 to 2 |
green |
continue routine assessments |
|
3 or 4 |
yellow |
increase frequency assessments; notify nurse or resident |
|
>= 5 |
red |
evaluate at bedside; notify attending physician |
