3 to 6.0 more than 12 hours before PICU admission to 9.5, 0 to 3 hours before PICU admission (P < 0.0001, Figure Figure2).2). The Brefeldin A ATPase square of the mid-point of the hour was also associated with the score (P = 0.005).Figure 2Progression of Bedside PEWS score with increasing proximity to urgent paediatric ICU admission. We present the mean of the maximum Bedside Paediatric Early Warning System (PEWS) score and standard error of the mean for time periods 0�C3, 4�C7, …Bedside PEWS scores of patients after ICU discharge and with urgent ICU consultationThere were 436 urgent CCRT consultation episodes for 309 patients (Table (Table4);4); 126 (29%) patient-episodes resulted in ICU admission within 24 hours of consultation. Patients who were urgently admitted had higher maximum Bedside PEWS scores (median 7 vs 4, P < 0.

0001) than patients who were not admitted. The Bedside PEWS scores from the initial visit were greater in patients who were admitted to ICU on the initial visit than those who were admitted later (median 7 vs. 5, P = 0.048).Table 4Inpatients with urgent consultation to the critical care response teamThere were 2975 patient visits performed for the 977 ICU discharge episodes. The median (IQR) Bedside PEWS score was 2 (1 to 4). The 15 patients who were re-admitted to the PICU had higher Bedside PEWS scores 8 (5 to 11) than patients who were not admitted (P < 0.0001).There were 4501 patient-visits made by the CCRT that did not result in urgent ICU admission. The Bedside PEWS scores were greater in patients who had shorter time to next planned review.

The proportion of episodes with Bedside PEWS scores of 8 or more, decreased from 24.5% in patients who were to be reviewed within four hours, to 0.5% of patients to be reviewed in 24 to 48 hours (Table (Table55).Table 5Planned review times for all patients remaining on ward after critical care response team consultationDiscussionWe describe the development and initial validation of the Bedside PEWS score. We reviewed 11 items, removed four, and created a seven-item score to quantify severity of illness in hospitalised children. The seven items in the Bedside PEWS score are heart rate, systolic blood pressure, CRT, respiratory rate, respiratory effort, transcutaneous oxygen saturation and oxygen therapy.

These four respiratory and three circulatory variables can be objectively measured in children who are awake and asleep, do not require laboratory or other diagnostic testing, suggesting that the Bedside PEWS score may be feasibly used in clinical practice. The score items have face validity and modest overlap with severity of illness scores for critically ill children in ICUs and emergency departments [13-17].We found that the Bedside PEWS score can differentiate between hospitalised Entinostat children with and without critical illness (AUCROC 0.91). This is at least equivalent to more complicated scores [4,8,15].