Systematic Review: The Effectiveness of Pediatric Early Warning Scores (PEWS) for the Early Detection of Critical Illness in Pediatric Emergency Departments.
DOI:
https://doi.org/10.64149/Keywords:
Pediatric Early Warning Score, PEWS, Pediatric Emergency Department, Critical Illness, ICU Admission, Clinical Deterioration, Pediatric TriageAbstract
Background: Pediatric Early Warning Scores (PEWS) are clinical tools designed to aid in the early identification of critical illness in children. Widely implemented in inpatient wards, the utility of PEWS in pediatric emergency departments (EDs) for early triage and detection of deterioration remains under investigation.
Objective: This systematic review evaluates the effectiveness of PEWS for the early detection of clinical deterioration and critical illness in pediatric emergency settings, focusing on its sensitivity, specificity, predictive accuracy, and implementation feasibility across varied clinical environments.
Methods: Twenty-five studies published between 2011 and 2025 were systematically reviewed using a comprehensive multi-database search strategy. Included studies examined the diagnostic utility, predictive value, and clinical outcomes associated with PEWS in pediatric EDs. Studies were appraised using standardized criteria and risk of bias tools.
Results: The review found that PEWS demonstrated moderate to high sensitivity (75%–90%) and acceptable specificity (65%–85%) in predicting deterioration and ICU admissions. The tool improved clinical communication and decision-making, especially when integrated with response systems. Implementation in low-resource settings was feasible but
presented adaptation challenges.
Conclusion: PEWS is an effective triage and monitoring tool in pediatric emergency settings. However, standardization, local adaptation, and electronic integration are essential for optimal utility. Further RCTs are needed to confirm causality and refine threshold values.
