Introduction: Timely identification of clinical deterioration in pediatric emergency settings is vital. The Pediatric Early Warning Score (PEWS) is a widely used bedside tool for rapid triaging in pediatric emergencies, but its association with physiological derangements remains under-explored.
Methods:
Methods: A Cross-sectional study was conducted over 12 months at the Pediatric Emergency Department. A total of 500 children aged 1 month to 14 years with a PEWS >3 was included. Simultaneously arterial and venous blood sampling was done and analysed for pH, PCO₂, PO₂, bicarbonate, lactate, and electrolytes. Pearson correlation analysis was used for statistical correlation between PEWS and blood gas parameters.
Results:
Results: This study demonstrated strong inverse correlations with PEWS, venous pH (r = -0.73) and arterial pH (r = -0.71), thus indicating severe acidemias at higher PEWS levels. Metabolic markers such as Bicarbonate (arterial r = -0.68, venous r = -0.69) and base excess (r = -0.66 for both) also showed strong negative correlations with PEWS. The lactate -PEWS correlation (r = 0.79) confirmed a strong association with metabolic stress. In contrast, oxygenation parameters (PO₂, SaO₂, SvO₂) and electrolytes (Na⁺, K⁺, Cl⁻) showed no meaningful correlation. This supports clinical relevance of venous blood gas analysis in evaluating acid-base and metabolic status in pediatric emergency care, while arterial sampling is still needed for oxygen analysis.
Conclusions: Strong correlation with acid-base and metabolic parameters from blood gas analysis with Pediatric Early Warning Scores (PEWS), highlights its value as clinical indicators of physiological deterioration. In contrast, oxygenation parameters showed poor correlation with PEWS, suggesting limited sensitivity to detect hypoxia. These findings supported the integration of venous blood gas assessment into PEWS-based frameworks for enhancing early recognition and management of critically ill children, while underscoring the need for arterial sampling wherever accurate oxygenation data is essential.
