Despite the extensive literature discussing PEWS in the inpatient setting, there are limited
published studies evaluating the utility of PEWS systems in the pediatric emergency
department (ED). To date, there are two studies evaluating the ability of PEWS systems to
predict which patients in the pediatric ED need admission to the intensive care unit (ICU). A
recent study from a pediatric hospital in the Netherlands evaluated the validity of multiple
PEWS scores. The authors tested the performance of ten different established PEWS in the
ED, with the discriminative ability of each PEWS determined to be poor to moderate for
predicting hospitalization and moderate to good for predicting ICU admission.14 A second
study by Breslin et al.15 sought to determine the association between PEWS at time of ED
disposition and level of care and included both admitted and discharged patients in the
cohort. The authors concluded that PEWS is associated with the level of care at ED
disposition, but cannot accurately be used in isolation.