1. Peds-818: Pediatric Early Warning Scores
TFQO: Ian Maconochie COI # 99
EVREVs: Alexis Topjian COI # 303
Taskforce: Antonio Rodriguez-Nunez COI # 14

2. COI Disclosure Alexis Topjian COI # 303
Antonio Rodriguez-Nunez COI # 14
Commercial/industry
None
Potential intellectual conflicts

3. 2010 CoSTR
Topic not reviewed in 2010

4. C2015 PICO Population: Infants and children in the in-hospital setting
Intervention: Use of a Pediatric Early Warning Score
Comparison: Not using a Pediatric Early Warning Score
Outcomes: Overall hospital mortality (7-critical)
Cardiac arrest frequency outside the ICU (6-important)

5. Inclusion/Exclusion & Articles Found
Inclusions/Exclusions
Inclusion: Observational retrospective or prospective, RCT, Pediatrics, Early Warning Score (of any type)
Exclusion: not related to the PICO question, evaluations of Rapid Response Teams, Abstracts
Number of articles initially identified: 1741
RCT: 0
Non-RCT: 1
Excluded: 1740

6. 2015 Proposed Treatment Recommendations
We suggest using a Pediatric Early Warning Score/ System for early detection of children at risk of respiratory or cardiac arrest in the in-hospital setting
(weak recommendation, very low quality of evidence).

7. Risk of Bias in studies

8. Evidence profile table(s)
Author(s): Alexis Topjian and Antonio Rodriguez-Nunez Date: 2 November 2014 Question: Should PEWS vs. No PEWS be used in in-hospital pediatric patients? Settings: Hospital mortality, Cardiac arrest outside ICU Bibliography (systematic reviews): None.
Quality assessment
№ of patients
Effect
Quality
Importance
№ of studies
Study design
Risk of bias
Inconsistency
Indirectness
Imprecision
Other considerations
PEWS
No PEWS
Relative (95% CI)
Absolute (95% CI)
CARDIAC ARREST 1
Randhawa, 2011
observational studies
serious  3
Not serious
serious  1
publication bias strongly suspected all plausible residual confounding would reduce the demonstrated effect  1
None
Specified
not estimable
⨁◯◯◯ VERY LOW
CRITICAL
MORTALITY AFTER CARDIAC ARREST
observational study
very serious  2
serious  2
⨁◯◯◯VERY LOW

9. Proposed Consensus on Science statements
For the critical outcome of incidence of cardiac arrest, we have identified evidence from one very low quality pediatric observational study (downgraded for risk of bias, indirectness, imprecision and possible publication bias) describing improved outcome with the use of PEWS in a hospital (Randhawa, 2011, 443)
For the critical outcome of reduced mortality from cardiac arrest, we have identified no evidence that showed changes in cardiac arrest rate or mortality outside of the PICU setting.

10. Draft Treatment Recommendations
We suggest using a Pediatric Early Warning Score/ System for early detection of children at risk of respiratory or cardiac arrest in the in-hospital setting
(weak recommendation, very low quality of evidence).

11. Knowledge Gaps
If PEWS independent of intervention have an impact on outcomes
Specific research required
Prospective research evaluating PEWS
Evaluating efficacy of different PEWS

12. Next Steps
This slide will be completed during Task Force Discussion (not EvRev) and should include:
Consideration of interim statement
Person responsible
Due date
Essential slide (one slide only). Estimated time <30 sec