ARTICLES
Sensitivity of the Pediatric Early Warning Score to
Identify Patient Deterioration
AUTHORS: Mari Akre, PhD, MS, MSN, RN, NEA-BC,a Marsha
Finkelstein, MS,b Mary Erickson, DNP, RN, CNP,c Meixia
Liu, MS,b Laurel Vanderbilt, RN,a and Glenn Billman, MDd
aClinical Nursing Administration, bResearch and Sponsored
Programs, and cPediatrics-Patient Support, Children’s Hospitals
and Clinics of Minnesota, Minneapolis, Minnesota; and dRady
Children’s Hospital, San Diego, San Diego, California
KEY WORDS
Pediatric Early Warning Score, screening tool, risk assessment,
clinical deterioration, Rapid Response Team, code blue, early
recognition
ABBREVIATIONS
RRT—rapid response team
PEWS—Pediatric Early Warning Score
APRDRG—All Patient Refined Diagnosis Related Groups
www.pediatrics.org/cgi/doi/10.1542/peds.2009-0338
doi:10.1542/peds.2009-0338
Accepted for publication Jan 7, 2010
Address correspondence to Mari Akre, PhD, MS, MSN, RN,
NEA-BC, Children’s Hospitals and Clinics of Minnesota, Clinical
Nursing Administration, 910 East 26th St, Suite 40-420,
Minneapolis, MN 55403. E-mail: mari.akre@childrensmn.org
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2010 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have
no financial relationships relevant to this article to disclose.
PEDIATRICS Volume 125, Number 4, April 2010
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WHAT’S KNOWN ON THIS SUBJECT: Two previous studies
addressed PEWS sensitivities to unplanned transfers to a higher
level of care.
WHAT THIS STUDY ADDS: No study has focused exclusively on
patients who experience and rapid response team or code call.
Neither has any addressed the lead time of recognition by using
PEWS.
abstract
OBJECTIVE: We evaluated the Pediatric Early Warning Score (PEWS)
sensitivity as an early indicator of patients deterioration leading to a
Rapid Response Team (RRT)/code event. We hypothesized that at least
80% of patients had a critical PEWS preceding the event. We determined
staff awareness of deterioration in patient status prior to the event as
evidenced by consults, addition of monitoring equipment or increased
frequency of assessment. The timing of these events was compared to
critical PEWS times.
METHODS: One hundred and seventy non-ICU RRT and 16 code events
were identified between October 2006 and February 2008. We com-
pleted retrospective PEWS at four-hour intervals or less for twenty-four
hours preceding the event. The PEWS algorithm, guiding staff to consult
at a critical score ⱖ4 or a single domain score equal to 3, was applied.
RESULTS: For 85.5% of patients the earliest indicator of deterioration,
evidenced by a critical PEWS, was a median of 11 hours 36 minutes and
the earliest preceding the event was 30 minutes. For 97.1% of patients
the earliest median time to a consult was 80 minutes. Oximetry was
added 6.9 hours for 43.5% of patients. 7% of patients had increased
nursing assessment. A sub-group of patients had 1) critical PEWS,
2) consult and 3) addition of a monitor. The median time for earliest
critical PEWS for these was significant (P ⬍ 0.001).
CONCLUSION: PEWS can potentially provide a forewarning time ⬎11
hours, alerting the team to adapt the care plan and possibly averting
an RRT or code. Pediatrics 2010;125:e763–e769
e763
Hospitalized pediatric patients are at
risk for sudden deterioration that re-
sults in respiratory and/or cardiac ar-
rest and death. Rapid response teams
(RRTs) have been put in place at many
hospitals to respond to these emer-
gencies.1–3 This departure from usual
chain-of-command for medical care is
intended to ensure that clinically dete-
riorating patients receive assistance
before their conditions are an emer-
gency. Although there has been evi-
dence of significant decreases in car-
diopulmonary code (code blue) rates
outside the ICU and deaths as a result
of RRT implementation, they have not
been eliminated.2,4 Efforts have shifted
to earlier recognition of change in
physiologic status by using objective
clinical indicators and risk tools. Ear-
lier response and interventions pro-
vide the opportunity to decrease the
need for calling the RRT.
Several adult and subsequent pediat-
ric early warning scores have been de-
veloped and refined.5–13 Haines et al10
used a retrospective record review
and nurse interview to evaluate trig-
ger criteria for patient identification of
high-dependence nursing care needs.
Their 14-item tool was based on crite-
ria for airway, breathing, circulation,
disability, and other selected diagnos-
tic elements. Duncan and colleagues8,9
reported on the development of a 20-
item early warning score. Their valida-
tion study suggested that three-
quarters of patients who requiring a
code blue call might have had at least a
1-hour warning on the basis of their
score. The Pediatric Early Warning Score
(PEWS), designed by Monaghan12 and
his team at the Children’s Hospital in
Brighton, England, is a more easily
scored tool that is based on only 5 do-
mains: behavior, cardiovascular sta-
tus, respiratory status, nebulizer use,
and persistent postsurgical vomiting.
The tool was further supported by an
algorithmic response that is based on
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the score. Quist-Therson11 and his
team at the Hertfordshire Partnership
NHS Trust Children’s Services in En-
gland adapted the Monaghan model by
using colors as indicators of deterio-
ration. The simplicity, efficiency, and
color-coded score hierarchy made it a
desirable choice for trial at Children’s
Hospitals and Clinics of Minnesota
(Children’s), a 325-bed facility located
at 2 urban sites in the cities of Minne-
apolis and St Paul. Tume14 examined
clinical observations of patients who
were transferred to a higher level of
care and found that PEWS would have
identified 87% of these patients who
were at risk for deterioration. Tucker
et al15 in a similar prospective study
described the sensitivity and specific-
ity of PEWS for detecting clinical dete-
rioration that results in unplanned
transfer to the PICU. They reported
sensitivity of 84.2% at a score of ⱖ4
and concluded that PEWS could iden-
tify children who require transfer.
We began our implementation and
evaluation of the Monaghan and Quist-
Therson PEWS tool in January 2008.
The primary objective of this retro-
spective study was to evaluate the sen-
sitivity of PEWS for a group of patients
who had a documented RRT or code
blue event as well as the lead time for
the earliest and latest critical PEWS be-
fore the event. We hypothesized that at
least 80% of patients had a critical
PEWS, defined as a score of ⱖ4 or a
domain score of 3, before the event. If
true, then this would provide evidence
of good sensitivity and support its use
in the pediatric inpatient setting to
identify early physiologic deteriora-
tion. A secondary objective was to ex-
amine staff awareness of deteriora-
tion in patient status before the event
and to determine whether use of PEWS
would have provided significantly ear-
lier recognition. We measured staff
awareness by key indicators of (1) con-
sultation with another nurse, physi-
cian, or respiratory therapist; (2) the
addition of monitoring equipment;
and/or (3) increased frequency of pa-
tient assessment.
METHODS
A retrospective chart review was com-
pleted on 170 RRT calls and 16 code
blue events that occurred for 186
unique patients between October 2006
and February 2008. All events occurred
on medical surgical units excluding
ICU and ICU step-down units. Study ap-
proval was obtained from Children’s
institutional review board.
Rationale
Code blue and RRT events were in-
cluded because they represent unex-
pected and/or critical deterioration
characteristics in some hospitalized
pediatric patients. In addition, assess-
ment and communication processes
are similar. At Children’s, employees,
patients, parents, and families may un-
conditionally request urgent medical
assistance (RRT) for a patient who is
perceived to be in distress without ad-
vance consultation with housestaff or
the patient’s attending physicians. We
tested the sensitivity of PEWS in this
population as an objective tool to pre-
dict critical deterioration and to sup-
port structured communication of pa-
tient status between team members.
RRT and code blue events provide mea-
surable outcomes that we hope to re-
duce with implementation of PEWS.
This was a retrospective study design
of cases before implementation of
PEWS. It is the only design that is not
contaminated by interventions in re-
sponse to PEWS. Once PEWS is imple-
mented, it becomes unclear as to
whether the event would have oc-
curred as a result of interventions that
are responses to critical PEWS.
Assignment of PEWS
PEWS are assigned in 3 domains: be-
havior, respiratory, and cardiovascu-

FIGURE 1
Children’s guide to PEWS.
lar. Scores in each domain can range
from 0 to 3 points (Fig 1). In addition, 2
points are added for nebulizations that
are continuous or every 15 minutes
and 2 points for persistent postopera-
tive vomiting. The total score can
range from 0 to 13.
PEWS were calculated for 24 hours be-
fore the event at intervals of at least 4
hours for each of the identified pa-
tients. This is consistent with assess-
ment frequencies for nurses on these
units. When assessment charting was
more frequent than 4 hours, additional
PEWS were calculated. Behavioral
scoring required the actual use of the
words shown in Fig 1, such as playing,
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sleeping, and/or irritable. During wak-
ing shifts, this would not be customary
documentation. When these words
were not documented, the item was
scored as missing. When data were not
available for a specific domain, it was
marked as missing. To ensure consis-
tency, a single “expert” performed all
scoring.
Training the Expert in PEWS
A licensed registered nurse with exten-
sive intensive care, rapid response,
and code blue experience reviewed pa-
tient charts and determined PEWS.
Working with a hospital advanced
practice nurse, they reviewed charts,
ARTICLES
discussed and refined the scoring
rules, and then independently scored
patients until interrater reliability
was achieved on a sample of 10 pa-
tient records. Our electronic medical
record included many more descrip-
tors of patient status than are included
in the tool, which required agreement
on which terms would be recom-
mended to staff to facilitate scoring
PEWS. One example is the option for
patient color. PEWS has 3 choices, and
the electronic medical record has 6. By
comparing their results data, interpre-
tation was refined until agreement
was achieved. This agreement of terms
for scoring was also used to train staff.
e765
PEWS Action Algorithm: Critical TABLE 1 Median Time From Critical PEWS or Domain Score to RRT or Code Blue Event (N ⫽ 186)
PEWS Parameter n (%) Earliest Instance Latest Instance
Before RRT or Code Before RRT or Code
We agreed to use the Monaghan12 cri- Blue Event, min Blue Event
teria that a total score of ⱖ4 or a score Median Range Median Range
of 3 in any of the PEWS domains re- Critical PEWS
flected a critical value that required a ⱖ4 147 (79.0) 615 5–1439 40 5–1438
consultative action. We refer to these ⱖ5 109 (58.6) 495 5–1438 35 5–1438
ⱖ6 82 (44.1) 195 1–1438 30 1–1438
criteria as critical PEWS.
ⱖ7 58 (31.2) 230 1–1438 30 1–1438
ⱖ8 30 (16.1) 63 1–1339 31 1–1260
Additional Data Collected ⱖ9 11 (5.9) 25 1–830 25 1–830
Critical domain score ⫽ 3
During the 24-hour pre-event period, Cardiovascular 92 (49.4) 820 1–1439 47 1–1439
we collected data on increased fre- Respiratory 96 (51.6) 1268 6–1439 55 1–1439
quency of nursing assessment and the Behavior 59 (31.7) 1055 5–1439 55 1–1439
Critical PEWS or domain score
addition of equipment, including pulse ⱖ4 or domain ⫽ 3 159 (85.5) 696 5–1439 30 1–1438
oximetry and cardiac monitoring. Con-
sultations by another nurse, physician,
or respiratory therapist were also col-
lected. The purpose was to evaluate event were compared by using the Pediatric Early Warning Score
these as indicators of staff awareness Friedman nonparametric test with a The sensitivity of PEWS was 85.5%, de-
of deteriorating patient status. An ex- 2-sided P ⬍ .05 required for signifi- fined as the patient’s having had a crit-
haustive review of multiple documen- cance. The nonparametric Wilcoxon ical score within 24 hours before the
tation elements such as nursing flow Signed Ranks test was used for paired event. As shown in Table 1, the median
sheets, nursing narrative notes, physi- comparisons of these median times time from the first critical PEWS to an
cian progress notes, and physician or- where a Bonferroni correction was ap- RRT or code event was 696 minutes (11
ders was used to retrieve data ele- plied requiring a 2-sided P ⬍ .015 for hours, 36 minutes) and the latest crit-
ments. Demographic data included significance. Because of the small ical score was 30 minutes for 159
age, gender, race, diagnosis, and All number of code blue events it was not (85.5%) of 186 patients in this study. A
Patient Refined Diagnosis Related possible to compare outcomes for total of 73.1% of patients had a critical
Groups (APRDRG)16 service line and these events to RRT events. SPSS 15.0 PEWS just before the RRT or code event
whether the patient had had surgery. (SPSS Inc, Chicago, IL) was used for (not shown in Table 1). The median
APRDRG is a recognized patient classi- statistical analysis. time from a critical PEWS just before
fication scheme available from 3M that the event was 30 minutes. Consistent
relates patient cost to his or her diag- RESULTS with pediatric patterns of compen-
nosis and comorbidities. APRDRG ser- sation, critical respiratory domain
vice line classification is 1 component Population Characteristics
scores (score of 3) were the earliest to
of this method. The median age of subjects was 25.5 precede the critical event at 21 hours,
months ranging from 0 –252 months. 8 minutes for 51.6% of patients.
Statistical Analysis Gender was 60% male and 40% female.
Sensitivity was defined as percentage Races included 55.9% white, 17.2% Consultations and Added
of patients who had a critical PEWS be- Black/African American, 7.5% Asian, Monitoring
fore the RRT or code event. Median and and 7% Hispanic/Latino. Only 23.1% of A total of 181 (97.3%) of 186 patients
range were used to describe continu- patients were surgical. Forty-six per- received at least 1 consultation from a
ous variables such as the time from a cent of patients received care from the variety of providers, including physi-
critical PEWS, first consultation, and APRDRG respiratory service line fol- cians, nurses, and respiratory thera-
first monitor added, to the time of the lowed by infectious disease (9.6%), pists. For first consultations, 159
RRT or code blue event. cancer care (4.8%), cardiac care (87.8%) included a medical doctor. The
For a subgroup of patients who had (1) (4.2%) and digestive disease (3.2%). median time from the first consulta-
a critical PEWS, (2) a consultation, and The remainder of patients received tion before the event was 80 minutes.
(3) addition of a monitor, median time their care from a variety of APRDRG As shown in Table 2, ⬎98% of study
from each of these to the RRT or code service lines. patients had pulse oximetry monitor-

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TABLE 2 Monitoring
Monitoring Preceding 24 h Added, n (%
Type Before Event, n of total)a
(% of total)
Oximetry 124 (66.7) 59 (31.7)
Cardiac 46 (24.7) 34 (18.3)
Increased NA 13 (7.0)
assessment
Any monitoring 124 (66.7) 81 (43.5)
NA indicates not applicable.
a Includes monitoring that may have been stopped and
then restored.
ing initiated before the RRT or code
blue event. This is used instead of car-
diac monitoring for patients who are
outside the ICU, and nurses can
independently initiate it. A total of
81 (43.5%) patients had monitoring
added during the 24-hour pre-event pe-
riod. The median time of the first addi-
tion of a monitor before the event was
6 hours, 54 minutes. This additional
monitoring was interpreted as evi-
dence of some staff awareness of
change in patient condition. Evidence
of documented increased frequency of
nursing assessment was rare at 7%.
We evaluated a subgroup of 72 pa-
tients who shared 3 common findings:
(1) critical PEWS; (2) clinician consul-
tation; and (3) addition of a monitor.
When all median times to the event
were compared, they were signifi-
cantly different (P ⬍ .001). The median
time to first consultation was 73 min-
utes, which was significantly less than
first critical PEWS at 602 minutes (10
hours, 2 minutes; P ⬍ .001). The me-
dian time for addition of a monitor was
406 minutes (6 hours, 46 minutes),
similar to critical PEWS (P ⫽ .42).
RRT Interventions and Subsequent
Placement in the PICU
Nearly 91% of patients who experi-
enced an RRT event received a signifi-
cant medical intervention: 37.1%
received oxygen, 27.1% received nebu-
lization, 21.1% received oral/nasal/
pharynx suctioning, 17.6% received
cardiac monitoring, and 21.1% re-
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ceived arterial blood gas/venous blood
gas. A total of 40 (23.5%) patients who
experienced an RRT event were moved
to the PICU. These outcomes are simi-
lar to those reported for Children’s by
Zenker et al.3
Code Blue
As shown in Table 3, for 9 of 16 patients
who experienced a code blue event and
also had a critical PEWS, the median
time from the earliest critical PEWS to
the critical event was 6 hours, 45 min-
utes and the latest was 55 minutes. The
remaining 7 patients did not have a
critical PEWS. Eight patients had addi-
tion of an oximeter at a median time of
7 hours, 20 minutes, and 3 patients had
no interruption of oximetry monitoring
during the 24 hours before the critical
event.
For all patients who experienced a
code blue event, significant comorbid-
ity existed. Six of the 16 experienced
prolonged seizure with hypoxia, 2 had
cardiopulmonary arrests, and 2 had
equipment failure related to trach-
ventilator dependence. The remaining
patients had sudden respiratory fail-
ure as a result of an acute event that
included apnea, aspiration, and airway
occlusion with cough. Twelve of the 16
patients who experienced a code blue
event were transferred to a higher
level of care, 3 remained on their unit,
and 1 was unresponsive to resuscita-
tion efforts and died.
DISCUSSION
We have shown that PEWS are likely to
be critical at points in time during the
24-hour period before an RRT or code
blue event, giving valuable forewarn-
ing. To our knowledge, this is the first
report of the evaluation of the sensitiv-
ity of the PEWS as an indicator of risk
for an RRT or code blue event during
the 24 hours before these events.
Tucker et al15 as well as Tume14 used
only unplanned transfer to a higher
ARTICLES
level of care as a measure of deterio-
ration. Also and as important, this is
the only study that documented the
lead time for which PEWS would have
signaled deterioration earlier than
standard clinical observation. Hospi-
talized pediatric patients are known to
exhibit prolonged compensatory stabi-
lization before decompensation. Earli-
est recognition and intervention on the
basis of any single critical PEWS could
support these children during their
compensatory phase and improve out-
comes and reduce cost of care. During
the compensatory phase, PEWS would
be expected to vary, depending on the
patient’s underlying diagnosis and co-
morbidities and ability to compensate.
This variation in comorbidities and the
ability to compensate may account for
the intermittent consultations on the
patients before the events and also ac-
count for ⬍100% critical scores for
the study patients. In addition, the se-
verity of comorbidity for patients who
experienced a code blue event contrib-
uted to sudden changes in physiologic
status that were not always signaled
by a critical PEWS, as shown in Table 3.
For the subgroup of patients who had
a combination of factors indicating
risk—(1) PEWS ⱖ4, (2) monitoring
added, and (3) at least 1 medical
consultation—the timing of these fac-
tors was noteworthy. The time for
added monitoring was not significantly
different from the earliest critical PEWS.
This close proximity of timing supports
the premise that PEWS is an objective
tool that validates nurses’ clinical ap-
praisal of their patient’s changing sta-
tus, yet PEWS ⱖ4 indicated a risk for de-
terioration 6 hours earlier than the first
documented medical consultation. This
is consistent with the discussion by An-
drews and Waterman7 of the need to
have “a definitive way to get doctors’ at-
tention and convince them to review
patients . . . by presenting quantifiable
evidence of deterioration” because
e767
TABLE 3 Time From Critical PEWS or Added Monitoring to Code Blue Event and Patient Status
Code Earliest Critical Latest Critical Oximetry Cardiac Comorbidity Status at Time of Code Transfer to Higher
PEWS, min PEWS, min Monitor, min Monitor, min Level of Care
1 Not critical Not critical Ongoing Not used Cerebral palsy: feeding difficulty Acute aspiration Yes
with aspiration
2 1168 418 Not used Not used Adult patient with CF refusing Acute coughing episode Yes
use of BiPAP/vest
3a 210 210 210 Not used Infantb after pyloric repair; Apnea Yes
undiagnosed central apnea
4 Not critical Not critical Not used 1359 RSV⫹; born preterm at 34 wk; Apnea Yes
24-h history of apnea spells
5 Not critical Not critical 484 Not used Septic shock with Cardiopulmonary arrest at Yes
DIC/meningococcemia; admission
intubated before admission
6 396 36 395 111 Infant: seizures and cortical Cardiopulmonary arrest Died
dysplasia who ALTE at home
7 585 45 907 Not used Born preterm at 25 wk; Respiratory failure Yes
increased stridor
8a 405 405 Not used Not used Global developmental delay; no Respiratory failure Yes
cough reflex; right middle
lobe pneumonia
9 Not critical Not critical 1138 Not used DeGeorge syndrome; status Seizure Yes
post-thymus transplantation;
new seizure
10 925 55 Not used Not used Medulloblastoma status Seizure Yes
postsurgery with multiple
complications
11 Not critical Not critical Ongoing Not used Meningitis sepsis, left subdural Seizure Yes
empyema
12a 9 9 200 Not used Schwachman-Diamond Seizure No
syndrome; acute varicella
13a 6 6 973 Not used Seizure disorder Seizure Yes
14 Not critical Not critical 13 Not used Spina bifida; seizure disorder Seizure Yes
15 Not critical Not critical Ongoing Ongoing Infant trach-ventilator Self-decannulated No
dependent
16 1305 705 Not used Not used Infant Pompe disease; trach- Ventilator: mechanical No
ventilator dependent failure
CF indicates cystic fibrosis; BiPAP, bilevel positive airway pressure; RSV, respiratory syncytial virus; ALTE, apparent life threatening event; DIC, disseminated intravascular coagulation.
a Had only 1 critical PEWS; therefore, the earliest and latest times are the same.

b Infant is younger than 12 months.

“quantifiable changes are used by doc-
tors to prioritize their workload.” The ac-
tions specified in the PEWS algorithm
supports nurses to consult with the
medical provider at the earliest time
that deterioration in patient status is
identified.
Nursing autonomy permits supportive
interventions to assist the compensat-
ing patient before consultation with
another clinician. In the absence of a
standardized tool, nurses rely on their
clinical attentiveness, intuition, and
subjective evaluation to interpret clin-
ical findings. Nurses do small interven-
tions in repeated cycles to maintain a
patient’s vital signs without recogniz-
ing that they are compensating for the
patient. Scoring from the normal pedi-
atric baseline, as with PEWS, could fa-
cilitate greater situational awareness
of the narrow range of patient changes
to be tolerated without consultation.
The results of this study clearly dem-
onstrate a prolonged period of patient
change, affording the opportunity for
consultation and intervention before a
level of decompensation that requires
an RRT or a code blue event. Evaluation
of tool sensitivity was important to
demonstrate the benefit of an objec-
tive assessment tool to support con-
cise, prompt team communication of
patient status changes over time. One
physician stated, “The nice thing about
PEWS is that a score of 4 is a 4 regard-
less of the nurse, their experience,
the unit, or the patient’s underlying
condition.”
There were several limitations to this
study. We depended on the accuracy of
patient charting and nursing notes to
generate retrospective PEWS. Nurses’
normalization to their patient popula-
tion influences their charting by excep-
tion and may have contributed to the
missing data elements in this retro-
spective review. Usually the missing
domains were behavior state at
25.4% because staff members do not
always document the alert state dur-
ing the day and Cardiovascular color
at 26.1% because staff members do
not tend to document normal status.

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Even under these conditions, we have
shown that PEWS was highly sensitive
in identifying patients’ deterioration
and was indicative of risk for an RRT or
code blue event. The percentage of pa-
tients with increased frequency of as-
sessment may have been higher than
the reported 7%; however, there was
not documentation to back up this be-
lief. The PEWS tool is relatively new. As
such, much of the data about its use
and results are not yet published, and
comparison of results is not possible.
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CONCLUSIONS
With 85.5% of patients having at least 1
critical PEWS before the RRT or code blue
event at a median time of ⬎11 hours, we
believe this to be a strong indicator of its
potential to alert the care provider of
clinical deterioration. Our results are ev-
idence that the PEWS can potentially play
a critical role in (1) quantifying patient
status, (2) supporting early recognition
of clinical deterioration, and (3) promot-
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ARTICLES
sponse to changing patient status. Addi-
tional studies are imperative to confirm
these findings and to describe potential
impact of PEWS on clinical outcomes
when there is earlier recognition of clin-
ical deterioration.
ACKNOWLEDGMENTS
We acknowledge our colleagues at Cin-
cinnati Children’s for sharing their
early experience with clinical imple-
mentations of PEWS and their ongoing
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e769
Sensitivity of the Pediatric Early Warning Score to Identify Patient Deterioration
Mari Akre, Marsha Finkelstein, Mary Erickson, Meixia Liu, Laurel Vanderbilt and
Glenn Billman
Pediatrics 2010;125;e763
DOI: 10.1542/peds.2009-0338 originally published online March 22, 2010;

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Sensitivity of the Pediatric Early Warning Score to Identify Patient Deterioration
Mari Akre, Marsha Finkelstein, Mary Erickson, Meixia Liu, Laurel Vanderbilt and
Glenn Billman
Pediatrics 2010;125;e763
DOI: 10.1542/peds.2009-0338 originally published online March 22, 2010;

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/125/4/e763

Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
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