**2.7 Pediatric early warning score (PEWS)**

Although sepsis is less common in the pediatric population compared with adults, it is more challenging to detect because symptoms like fever and tachycardia, heralding signs in adults, frequently accompany mild illness in pediatric patients. Thus, the ability to detect and differentiate patients at risk for deterioration is even more crucial.

The bedside pediatric early warning score (PEWS) includes seven variables determined by expert consensus: heart rate (HR), capillary refill time (CRT), respiratory rate (RR), respiratory effort, systolic blood pressure (sBP), transcutaneous oxygen saturation, and oxygen therapy [17]. Each variable's ability to discriminate between control and case patients was assessed by logistic regression. HR, RR, respiratory effort, and oxygen therapy had AUROC > 0.75 while CRT, oxygen saturation, sBP, and temperature had intermediate AUROC scores between 0.65 and 0.74 [17]. Temperature was ultimately excluded as a variable due to little added value. Bedside PEWS' AUCROC was 0.91 with a sensitivity of 82% and specificity 93% at a threshold score of eight [17]. Bedside PEWS is sensitive in detecting deterioration with scores increasing 24 hours prior to urgent escalation of care and can identify patients at risk within at least 1 hour's notice of sepsis [18].
