Recognising the Warning Signs: Can a New Early Warning System Help Prevent Children Dying from Sepsis?
Posted on in Medical Negligence
The expansion of the National Paediatric Early Warning System (PEWS) into Accident and Emergency departments across England is an important and welcome development in the ongoing effort to improve patient safety and prevent avoidable deaths among children.
As reported in the recent BBC News article, 'Early warnings to save lives', the system is designed to help busy NHS staff identify children whose conditions are deteriorating, ensuring that warning signs are recognised promptly and appropriate medical intervention takes place without delay.
For families who have experienced the devastating consequences of a missed or delayed diagnosis of sepsis, this announcement will carry particular significance. It is a reminder that recognising deterioration early, undertaking appropriate observations and acting on concerns can quite literally mean the difference between life and death.
Why early recognition matters
Sepsis is a life-threatening response to infection which can cause rapid deterioration and, without timely treatment, lead to organ failure, life-changing injuries or, in the very worst cases, death. In children, recognising the signs can be particularly challenging. Symptoms may initially appear relatively non-specific, and a child's condition can deteriorate alarmingly quickly.
When warning signs are missed
As a medical negligence lawyer at Tozers, acting for families following the death of a child, I have seen the devastating consequences when warning signs have not been recognised or acted upon appropriately.
Cases can involve children attending A&E with symptoms of serious infection, where observations are either not undertaken at appropriate intervals, not properly recorded, or not interpreted in the context of the child's overall presentation. Sometimes, observations reveal amber or red flags indicating deterioration, but the significance of those findings is not fully appreciated or acted upon.
There can also be delays in seeking a paediatric review, escalating concerns to senior clinicians or transferring a child to an appropriate clinical environment for closer monitoring and treatment.
In the most tragic cases, a child continues to deteriorate, progressing to septic shock, cardiac arrest and, sadly, death.
For parents, the consequences are unimaginable. They attend hospital expecting their child to receive the care and treatment they need. They may repeatedly express concerns that their child is becoming increasingly unwell, only to feel that those concerns are not being heard or acted upon.
A standardised approach to recognising deterioration
The new National PEWS initiative aims to address some of these concerns by introducing a consistent approach to monitoring children in emergency departments.
The system requires clinical staff to check, record and grade vital signs, including heart rate, blood pressure and oxygen levels. The overall score helps identify children who require increasingly urgent attention, with age-appropriate assessments for babies, younger children and teenagers.
Importantly, escalation is not dependent solely on the numerical score. Concerns raised by healthcare professionals, parents, carers or the child themselves, depending on their age, should also trigger an immediate escalation of care.
This is particularly important. A scoring system can provide an invaluable framework, but it cannot replace clinical judgement. Nor should a reassuring score override a parent's concern that their child is seriously unwell.
The system has already been used in more than 90 hospitals across England in children's wards, and its extension into emergency departments represents a significant step towards more consistent recognition of deterioration.
However, its effectiveness will depend on how it is implemented. Observations must be undertaken at the appropriate intervals, accurately recorded and interpreted. Staff must understand what the scores mean and, critically, know what action is required when a child triggers an amber or red warning.
A score is only useful if it leads to an appropriate response. Identifying deterioration without ensuring timely clinical review, escalation and treatment will not deliver the improvements that children and their families need.
Learning from mistakes
The BBC's reporting also highlights the tragic death of two-year-old Finlay Roberts in 2024, who spent hours in a hospital corridor before being discharged. A coroner raised concerns about the lack of basic observations undertaken by busy staff.
His death brings into sharp focus the risks associated with overcrowded emergency departments, prolonged waiting times and children being cared for in environments where appropriate monitoring and timely assessment may be difficult.
Children must be assessed and monitored in appropriate clinical environments, with clear pathways for escalation to paediatric specialists when concerns arise.
On responding to the article, my client has explained:
“It is gratifying to see that a new, standardised early warning system is being introduced to help identify signs of deterioration in children more quickly, and to give additional weight and importance to parental concerns. The pre-existing systems were inconsistent and haphazard. My son died from sepsis after contracting invasive Group A Strep, after numerous symptoms that were not taken seriously, our parental concerns were not listened to, and a basic observation was not carried out. I sincerely hope that the new system gives parents greater confidence that their concerns will be heard, their children will receive the care they deserve, and that future preventable deaths can be avoided.”
A step in the right direction
The introduction of PEWS into emergency departments, alongside the expansion of Martha's Rule, offers genuine hope that more children will receive the timely assessment and treatment they urgently need.
For families who have lost a child following failures to recognise the warning signs of sepsis, these developments cannot undo what has happened. But they provide an opportunity to learn from previous tragedies and improve the standard of care for children in the future.
Ultimately, no scoring system can guarantee that every case of sepsis will be recognised or every death prevented. However, consistent observations, appropriate interpretation of warning signs, prompt escalation to paediatric specialists and, above all, listening to parents can help prevent avoidable deterioration.
How we can help
If you believe you or a loved one experienced negligence due to unrecognised or untreated sepsis, we are here to help.
At Tozers, our specialist medical negligence team regularly supports families who have suffered the consequences of delayed or inadequate sepsis treatment.
If your family has been affected by sepsis or similar failures in hospital care, contact our dedicated medical negligence team for a confidential consultation.