The Use of a Modified Pediatric Early Warning Score to Assess Stability of Pediatric Patients During Transport

Objective: Pediatric early warning scores (PEWSs) have been used effectively in limited patient care areas. Children's Transport, at Children's Healthcare of Atlanta, transports approximately 5000 children annually. In an effort to consistently assess patient acuity and the impact of our team's interventions, we instituted a modified "transport PEWS" (TPEWS). Methods: The existing PEWS was modified to reflect the transport environment. A retrospective chart review was conducted of 100 consecutive children transported by Children's Transport in March 2009. Transport PEWS given during triage by the dispatch center (TPEWS tri ), TPEWS calculated at referring facility by the team (TPEWS ref ), and final TPEWS at the accepting institution (TPEWS acc ) were compared. Results: Eighty-six patients were transported by ground. The median age was 50.4 months. Sixty patients (60%) received some intervention from the transport team. Median TPEWS ref was 3 (0-9) upon initial assessment, and TPEWS acc was 2 (0-9) on arrival at the accepting facility (P = 0.0001). Seventy-three percent (73/100) of patients were transported to the emergency room; 15 (15%) of 100 to the general inpatient area, and 12 (12%) of 100 to the intensive care unit. In addition, a triage TPEWS (TPEWS tri ) was calculated from information given from the referring facility in 59 of the 100 patients. A significant difference in TPEWS tri and TPEWS ref was noted (P = 0.0001). Conclusions: In this cohort of pediatric transport patients, TPEWS appears to be a helpful additional assessment tool. Transport PEWS may function as a tool for assessing severity of illness, hence optimizing transport dispatch and patient disposition.