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Jurnal Kesehatan Pasak Bumi Kalimantan, Vol 3 No 1, 1 Juni 2020 pISSN : 2654-5241 eISSN :

Artikel Review

Overview Of The Pediatric Early Warning System Score In

Patient Care Placement: A Systematic Review
Yunisa1, Tuti Seniwati2, Mulhaeriah3

Abstrak
Latar Belakang: Sistem Peringatan Dini Pediatrik (PEWS) berfungsi untuk menurunkan angka kematian di rumah
sakit dan berpotensi baik untuk menentukan pasien perlu atau tidak untuk mendapatkan perawatan intensif. Tujuan:
Penelitian ini bertujuan untuk mendeskripsikan skor PEWS dalam penentuan ruang perawatan pasien. Metode: Yang
digunakan adalah review sistematis dengan mencari jurnal yang berkaitan dengan topik skor PEWS dalam
menentukan pasien dengan mengikuti pedoman checklist MOOSE. Pencarian literatur dilakukan di database PubMed,
Proquest, Google Scholar dan Science Direct. Hasil: Dari 19.366 artikel yang teridentifikasi, terdapat lima artikel yang
memenuhi kriteria inklusi. Anak yang paling banyak ditemukan dalam penelitian ini adalah anak laki-laki, berusia satu
sampai lima tahun dengan penyakit infeksi, pernafasan dan hematologi. Anak diperbolehkan pulang dengan skor
PEWS ≤2, rawat inap dengan skor 3 atau 4, perawatan intensif dengan skor ≥5. Kesimpulan dan Saran: Skor PEWS
sangat mempengaruhi kebutuhan ruang perawatan pasien. Anak yang memiliki skor PEWS tinggi akan dirawat di unit
perawatan intensif dan perawat yang menentukan ruang perawatan berdasarkan skor PEWS harus terus
menindaklanjuti anak tersebut.
Kata kunci: Kata kunci: PEWS, skor peringatan dini, anak

Abstract
Background: Pediatric Early Warning System (PEWS) functions to reduce mortality rates in the hospital and has good
potential to determine patients needed or not to receive intensive care. Aims: The aims of the study to describe the
PEWS score in determining the patient care room. Methods: Used is a systematic review by searching for journals
related to the topic of PEWS scores in determining patient by following the MOOSE checklist guidelines. The literature
search was on the PubMed, Proquest, Google Scholar, and Science Direct databases. Results: From 19,366 articles
identified, five articles fit the inclusion criteria. The most children found in this study were boys, aged one to five years
with infectious, respiratory, and hematological diseases. Children are allowed to go home with a PEWS score of ≤2,
hospitalization with a score of 3 or 4, intensive care with a score of ≥5. Conclusions and suggestions: The PEWS
score greatly influences the needs of patient care rooms. The child with a high PEWS score will be admitted to the
intensive care unit and the nurse who determines the treatment room based on the PEWS score must continue to
follow up with the child.
Keywords: PEWS, early warning score, children

Affiliasi penulis : 1Student of Nursing Study Program, Faculty of

Nursing Hasanuddin University, Makassar, Indonesia. 2 Pediatric
Nursing Department, Faculty of Nursing Hasanuddin University,
Makassar, Indonesia. 3
Maternity Nursing Department, Faculty of
Nursing Hasanuddin University, Makassar, Indonesia .
Korespondensi : Tuti Seniwati” tutiseniwati@unhas.ac.id
Telp: +6281354915399
INTRODUCTION
Regulation of the Minister of Health of the
Republic of Indonesia Number 47 of 2018
Concerning Emergency Services stated that
an emergency is a condition in which
patients need immediate medical action to
save lives and prevent permanent disability
due to delay or lack of proper treatment
(Peraturan Menteri Kesehatan Republik
Indonesia, 2018). Pediatric patients enter the
emergency room with different diseases and
conditions. Based on research conducted in
Ethiopia, it is known that the three highest
causes of death in the emergency room for
children are cardiovascular disease (27.8%),
respiratory disease (26.2%), infection
(25.5%) and hematology (10.7%) (2). While
research conducted by Zhu et al., (2015)
stated that internal disease (65.1%),
respiratory disease (14.8%), neuromuscular
disorders (14.3%), cardiovascular disease
(12.6%), and hematology (9.1%) are causes
of death in the emergency room for children.
Research conducted in Indonesia, most
cases of child mortality in the ER RSUD. Dr.
Soetomo Surabaya is sepsis with respiratory
failure (35.3%) and meningoencephalitis
(25.3%) (Dharmawati, Setyaningtyas, &
Kusumastuti, 2017) and the three highest
causes of death in IGD RSUP. Dr. Wahidin
Sudirohusodo Makassar is circulatory
system diseases, poisoning, and diseases of
the nervous system (4).
In a study conducted in Tikur (Africa), the
proportion of deaths in pediatric emergency
departments was 4.1% (499 patients) out of
12,240. This study showed a mortality rate of
8.2 deaths from 1000 patients per year (2).

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Jurnal Kesehatan Pasak Bumi Kalimantan, Vol 3 No 1, 1 Juni 2020 pISSN : 2654-5241 eISSN :
The study was conducted in Arizona (United
States) as many as 1,928,409 children
visited the children's emergency department
with a mortality rate of 5.2 deaths per
100,000 visits to the children's emergency
room (5). Whereas in China (Asia) there
were 0.5% (230 patients) out of 43,925,
indicating a mortality rate of 0.5 cases out of
1000 (3).
Pediatric patients are patients who have a
high risk of experiencing problems related to
emergency cases such as breathing or
cardiac arrest to lead to death, even though
the available equipment and medicines are
very adequate (6). To overcome this, an
appropriate and reliable identification tool is
needed. Pediatric Early Warning System
(PEWS) is a tool to identify or early warning
pediatric patients who are at risk of clinical
deterioration (7). From the results of reviews
conducted by (8), regarding PEWS research
conducted in developing countries, it was
found that the effect of PEWS application
showed a decrease in clinical deterioration
and a decrease in mortality.
In determining patient care, PEWS
functions as a potentially very good
screening tool to determine whether or not
patients need to receive care at the Intensive
Care Unit (9). In line with research results by
Agulnik et al., (2017), it was found that the
PEWS score significantly influences the
indications for hospitalization in the PICU
and PEWS has a specificity of 93% and a
sensitivity of 88%. Meanwhile, Oliveira et al.,
(2017) revealed that PEWS has a sensitivity
of 73.9%, a specificity of 95.5%, a positive
predictive value of 73.3%, a negative
predictive value of 94.7%, where these
values show good performance and are
considered valid to determine whether or not
the patient is placed in the PICU.
Several hospitals have implemented this
PEWS system to assess the condition of
pediatric patients in the ER. Therefore, this
study aims to review articles about the
description of the PEWS score in
determining patient care.
METHOD
Design
The design used for this scientific study is a
systematic review. Systematic review
studies are a method used to collect data or
sources related to the topic of the Pediatric
Fakultas Kedokteran Universitas Mulawarman
2
Early Warning System Score overview in
determining patient care.
Search Method
The literature search was carried out in
August - September 2020. The data used
are secondary data taken from the results of
previous research with a national and
international reputation. A literature search
using databases: Google Scholar, Science
Direct, PubMed, and Proquest, using
keywords based on Medical Subject
Heading (MeSH) and combined with AND
operators, namely "Pediatric Early Warning
Score" and "Determination of Care" and
"Pediatric Early Warning Score "AND"
Patient Admission ". These keywords are
based on PICO where P (pediatric patients),
I (no intervention), C (no comparison), and O
(the outcome of the Pediatric Early Warning
Score and placement of treatment rooms).
The research was performed using the
Search Engine on Mozilla Firefox version
80.0.1 and Google Chrome version
81.0.4044.138 combined with the Mendeley
Importer. Through Mendeley Desktop
version 1.19.4, duplication and screening of
titles and abstracts will be carried out.
Articles obtained and following the inclusion
and exclusion criteria are downloaded or
taken for further analysis.
Inclusion and exclusion criteria
Inclusion criteria were articles published
from 2010 - 2020 discussing the topic of
PEWS in the ER, the research subject
were pediatric patients, using English and
Indonesian, and reports with full text. At
the same time, the excluded articles were
articles that were not pure research and
were not full text.
Quality assessment and Data Extraction
The quality assessment of articles was
conducted using tools from the Joanna
Briggs Institute. The articles that have been
selected are extracted, including the name of
the researcher and the year of publication,
country, the purpose of writing, design, and
research sample method, the instrument
used, and the findings of the article. The
summary of the research article is analyzed
in the research results section.
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Jurnal Kesehatan Pasak Bumi Kalimantan, Vol 3 No 1, 1 Juni 2020 pISSN : 2654-5241 eISSN :

HASIL The other research reported that the

Of the 19,366 articles identified, five PEWS score range 0-5 indicates patients
articles fit the inclusion criteria based on the are discharged, the score range 0-7 patients
PRISMA flowchart. Two articles are are placed in ward, and the score ranges
quantitative studies with descriptive research from 0-9 patients are placed in intensive
designs (Wahyudi et al., 2014; Chaiyakulsil care (12). According to research Elita et al.,
& Pandee, 2015), and three prospective (2016), range score 0-6 are placed in the
observational studies (Breslin et al., 2014; inpatient room and the child who has score
Vredebregt et al., 2018; Elita et al., 2016). 4-9 are placed in the PICU room. According
This study was conducted in various to Wahyudi et al., (2014), children who have
countries around the world. Two studies a score of 2 are declared stable and allowed
were conducted in Indonesia, and three to go home, patients with scores of 2, 3, 4,
came from the United States, the and 5 are treated in the inpatient room, and
Netherlands, and Thailand. patients with scores of 6,7 and 8 were
According to table 4.1, the results of the admitted to the PICU / NICU.
PEWS score study for the determination of
care using the MPEWS are from
Chaiyakulsil & Pandee, (2015), who reported
a PEWS score ≥1 will enter the inpatient
room, while a score ≥ 3 will join the intensive
care room. Whereas the results of other
studies reported children who have a low
score of PEWS (<5) would be placed in the
inpatient room, while children who have a
high score ≥5 would be placed in the
intensive room (13).
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Table 1 Synthesis Grid Review Articles

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PEMBAHASAN
Isi Artikel Arial 11
SIMPULAN
Isi Artikel Arial 11
UCAPAN TERIMA KASIH (jika ada)
Isi Artikel Arial 11
DAFTAR PUSTAKA
1. Permenkes. Peraturan Menteri Kesehatan
Republik Indonesia Nomor 47 tahun 2018
Tentang Pelayanan Kegawatdaruratan.
2018 p. 121.
2. Jofiro G, Jemal K, Beza L, Bacha Heye T.
Prevalence and associated factors of
pediatric emergency mortality at Tikur
Anbessa specialized tertiary hospital: A 5
year retrospective case review study.
BMC Pediatr. 2018;18(1):1–10.
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mortality of patients in a pediatric
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4. Lotfi ABM. Profil kematian pasien kurang
8 jam di instalasi gawat darurat RSUP.
Dr. Wahidin Sudirohusodo Makassar.
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The impact of a pediatric emergency
department facility verification system on
pediatric mortality rates in Arizona. J
Emerg Med. 2017;52(6):894–901.
6. Wahyudi P, Indriati G, Bayhakki.
Fakultas Kedokteran Universitas Mulawarman
5
Gambaran Skor Pediatric Early Warning
Score ( Pews ) Pada Pola Rujukan
Pasien Anak Di Instalasi Gawat Darurat.
Jom Psik. 2014;1(2):1–8.
7. Gold DL, Mihalov LK, Cohen DM.
Evaluating the Pediatric Early Warning
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8. Brown SR, Garcia DM, Agulnik A.
Scoping review of pediatric early warning
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9. Chaiyakulsil C, Pandee U. Validation of
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10. Agulnik A, Aceltuno AM, Robles LNM,
Forbes PW, Vasquez DJS, Mack R, et al.
Validation of a pediatric early warning
system for hospitalized pediatric oncology
patients in a resource-limited setting.
2017;1–11.
11. Oliveira J De, Miranda F, Camargo CL
De, Portela DS, Monaghan A. Accuracy of
a pediatric early warning score in the
recognition of clinical. 2017;1–7.
12. Breslin K, Marx J, Hoffman H, McBeth R,
Pavuluri P. Pediatric early warning score
at time of emergency department
disposition is associated with level of
care. Pediatr Emerg Care. 2014;30(2):97–
103.
13. Vredebregt SJ, Moll HA, Smit FJ,
Verhoeven JJ. Recognizing critically ill
children with a modified pediatric early
warning score at the emergency
department, a feasibility study. Eur J
Pediatr. 2018;229–34.
14. Elita L, Triratna S, Bahar E. Validation of
the Pediatric Early Warning Score to
determine patient deterioration from
illness. Paediatr Indones. 2016;56(4):251.
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Jurnal Kesehatan Pasak Bumi Kalimantan, Vol 3 No 1, 1 Juni 2020 pISSN : 2654-5241 eISSN :

Isi Artikel Arial 11 (Menggunakan Mendeley

dengan Style “Vancouver”)

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