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Brighton Paediatric Early Warning Score (PEWS)

The Brighton PEWS (0–13) scores behaviour, cardiovascular and respiratory status (0–3 each), plus 2 for quarter-hourly nebulisers and 2 for persistent post-operative vomiting. Higher scores mean deterioration; a score ≥4 or 3 in any single domain commonly triggers medical review (thresholds are set locally).

Behaviour: Playing / appropriate (0); Sleeping (1); Irritable (2); Lethargic / confused, or reduced response to pain (3)
Cardiovascular: Pink, or capillary refill 1–2 s (0); Pale, or capillary refill 3 s (1); Grey, or capillary refill 4 s, or HR 20 above normal for age (2); Grey and mottled, or capillary refill ≥ 5 s, or HR 30 above normal, or bradycardia (3)
Respiratory: Within normal parameters, no recession or tracheal tug (0); RR > 10 above normal, accessory muscles, or ≥ 30% FiO₂ / ≥ 3 L/min (1); RR > 20 above normal, recession, tracheal tug, or ≥ 40% FiO₂ / ≥ 6 L/min (2); RR 5 below normal with sternal recession, tug or grunting, or ≥ 50% FiO₂ / ≥ 8 L/min (3)
Quarter-hourly (every 15 min) nebulisers (yes/no, +2)
Persistent vomiting after surgery (yes/no, +2)

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Interpretation

Result	Meaning
0–2	Routine observations
3	Increased frequency of observations; inform nurse in charge
≥ 4, or 3 in any domain	Medical review; escalate urgently at higher scores (thresholds vary by institution)

Formula

Behaviour 0–3 + Cardiovascular 0–3 + Respiratory 0–3 + 2 (nebulisers every 15 min) + 2 (persistent post-operative vomiting); maximum 13

Clinical pearls

"Normal parameters" for heart and respiratory rate are age-specific; use your unit's reference chart.
Escalation thresholds are institution-specific; the score supports, not replaces, clinical concern (including parental concern).

Examples

pews irritable, pale, recession on 40% oxygen brighton pews sleeping child, pink, normal breathing pews lethargic, grey and mottled, grunting, q15 nebs

FAQ

What PEWS score needs escalation?

In the Brighton system a total of 4 or more, or 3 in any single domain, usually triggers medical review; local protocols set the exact thresholds.

What is the maximum Brighton PEWS?

13: three domains of 0–3 plus 2 points each for quarter-hourly nebulisers and persistent post-operative vomiting.

Evidence

Monaghan A. Detecting and managing deterioration in children. Paediatr Nurs 2005;17(1):32–5.

Pediatrics & Obstetrics · Reviewed 2026-10-14 · Methodology