Implementation of the Pediatric Early Warning Scorefor the early identification of clinical deterioration in anArgentine hospital

Introduction. Unexpected clinical deterioration in hospitalized pediatric patients can precede serious events and unscheduled transfers to the pediatric intensive care unit (PICU). Early warning scales, such as the Pediatric Early Warning Score (PEWS), aim to facilitate its early detection. The objective was to implement PEWS use in at least 50% of hospitalized patients and to describe clinical variables associated with unscheduled transfers. Population and methods. A quasi-experimental before-and-after study was conducted at a pediatric hospital between April 2024 and January 2025. A SAFE (Situational Awareness for Everyone) situational awareness protocol was implemented, along with the use of the PEWS, staff training, briefings, and debriefing sessions. The study included patients aged 1 month to 18 years who were admitted to the PICU unscheduled. Adherence to PEWS documentation and associated clinical variables were evaluated. Results. A total of 104 unscheduled transfers were recorded (46 pre-intervention, 58 post-intervention). The groups were comparable in terms of age, comorbidities, days before transfer, length of stay in the PICU, and PIM3. Adherence to the PEWS was 58.6% in the post-intervention phase, increasing to 100% by the end of the period. The median PEWS score for unscheduled transfers was 6 (IQR 3-7). No differences were observed in the need for intervention within the first hour in the PICU or in mortality. Conclusion. The implementation of the PEWS was feasible and exceeded the proposed target. It had no clinical impact at this stage, but the high adherence achieved is key for future evaluations of effectiveness and sustainability.