Dear Dr Harris Re: Preventing Future Deaths Report for Master Peter Kollar Thank YoU for asking the Royal College of Emergency Medicine to consider this tragic case. We are committed to learning from cases where there have been bad outcomes_ The specific question we have been asked to consider is whether the presence of jaundice should be added to the Paediatric Early Warning Score (PEWS) This question was discussed in detail at the most recent meeting of the Quality Emergency Care Committee of the Royal College. This group is comprised of around 30 experienced Consultant Emergency Physicians with specific expertise in patient safety and best practice_ Early Warning Scores are usually developed by rigorous primary research studies. The presence of jaundice after the immediate neonatal period is rare. Many other features that would indicate & seriously ill child are not part of the PEWS, such aS abnormal cry or bulging fontanelle. Early Warning Scores are never designed to replace clinical judgement; but merely indicate to a clinician that the patient may be ill, The group unanimously concluded that would not be justifiable or effective to amend the Paediatric Emergency Warning Score to include jaundice_