The Primary Health Early Warning Score (PHEWS) is specifically adjusted for use in primary care. It can help to identify sepsis in the elderly. The author is from Waiuku Medical Center in New Zealand.
Parameters involving measurements:
(1) respiratory rate in breaths per minute
(2) temperature in °C
(3) systolic blood pressure in mm Hg
(4) heart rate in beats per minute
(5) oxygen saturation in percent
(6) level of consciousness
Parameters for red flag background data:
(7) continuity of care or notes (previous medical contact, good patient notes)
(8) age in years
(9) number of comorbidities
(10) immunosuppression therapy
(11) family support
Parameters for red flag symptoms:
(12) confusion
(13) diarrhea with or without vomiting
|
Parameter |
Finding |
Points |
|
respiratory rate |
<= 8 breaths per minute |
3 |
|
|
9 to 11 breaths per min |
1 |
|
|
12 to 20 breaths per min |
0 |
|
|
21 to 25 breaths per min |
1 |
|
|
26 to 29 breaths per min |
2 |
|
|
>= 30 breaths per minute |
3 |
|
temperature |
<= 35.0°C |
3 |
|
|
35.1 to 36.0°C |
1 |
|
|
36.1 to 38.0°C |
0 |
|
|
38.1 to 39.0°C |
1 |
|
|
>=39.1°C°C |
2 |
|
systolic blood pressure |
<= 90 mm Hg |
3 |
|
|
91 to 100 mm Hg |
2 |
|
|
101 to 110 mm Hg |
1 |
|
|
111 to 220 mm Hg |
0 |
|
heart rate |
<= 40 beats per minute |
3 |
|
|
41 to 50 beats per min |
1 |
|
|
51 to 90 beats per min |
0 |
|
|
91 to 110 beats per min |
1 |
|
|
111 to 130 beats per min |
2 |
|
|
>= 131 beats per minute |
3 |
|
oxygen saturation |
>= 96% |
0 |
|
|
94 to 95% |
1 |
|
|
92 to 93% |
2 |
|
|
<= 91% |
3 |
|
level of consciousness |
alert (A) |
0 |
|
|
responds to voice (V), responds to pain (P), unresponsive (U) |
3 |
|
continuity of care or notes |
yes |
0 |
|
|
no |
1 |
|
age |
< 65 years |
0 |
|
|
65 to 80 years |
1 |
|
|
> 80 years |
2 |
|
comorbidities |
0 or 1 |
0 |
|
|
2 to 4 |
1 |
|
|
>= 5 |
2 |
|
immunosuppression |
no |
0 |
|
|
yes |
1 |
|
family support |
no |
1 |
|
|
yes |
0 |
|
confusion |
none or stable |
0 |
|
|
new onset or increase in previous confusion |
1 |
|
diarrhea |
no |
0 |
|
|
yes |
1 |
measurement score =
= SUM(points for all 6 measurements)
red flag background score =
= SUM(points for all 5 background parameters)
red flag symptom score =
= SUM(points for both symptoms)
Interpretation:
• minimum score: 0
• maximum measurement score: 18
• maximum red flags background data score: 7
• maximum red flags symptoms score: 2
• The higher the score the worse the patient's condition.
The patient should be hospitalized if one or more of the following are present:
(1) the measurement score is >= 2
(2) the background data score is >= 2
(3) the symptom score is >= 1
