Correspondence questions evidence for DA-PEWS pediatric transport triage safety

Correspondence in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine challenges the interpretation of a pilot study evaluating the Dutch Ambulance Pediatric Early Warning Score (DA-PEWS). The study assessed scheduled interhospital transfers of children already considered cardiorespiratorily stable and allocated to medium-complexity ambulances, later expanding to low-complexity ambulances. Younger children from most referring hospitals were excluded because national protocols assigned them directly to high-complexity transport.

The correspondence authors argue that this selection excludes children at the clinically important boundary between transport categories. Decisions about transport safety and team composition had largely preceded enrollment, limiting conclusions about the score’s ability to guide those decisions. They distinguish perceived improvements in awareness and communication from evidence that DA-PEWS appropriately changes transport allocation or predicts clinically important events. No new datasets were generated or analyzed.

The authors propose prospectively evaluating all pediatric transfer requests before team allocation, initially calculating DA-PEWS without influencing dispatch and comparing it with independent clinical assessment. Suggested outcomes include unplanned escalation, emergency interventions during transport, urgent intensive care admission after arrival, score overrides, and adverse events. This methodological commentary does not demonstrate that DA-PEWS is unsafe; it argues that triage safety remains unestablished in children whose transport requirements are uncertain.