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Mortality predictors in pediatric emergency department presentations: a systematic review and meta-analysis

Mohammed Alsabri1,2, Mohamed A ELKarargy3, Israa Magdy Ata4

  • 1Emergency Department, Althawara Modern General Hospital, Sanaa, Yemen. Alsabri5000@gmail.com.

BMC Emergency Medicine
|September 27, 2025
PubMed

Insights

The Pediatric Early Warning Score (PEWS) effectively identifies low-risk pediatric patients, but clinical judgment is essential for accurately assessing high-risk cases in emergency departments.

Area of Science:

  • Pediatric Emergency Medicine
  • Clinical Risk Assessment
  • Health Services Research

Background:

  • Pediatric patients in emergency departments (EDs) exhibit diverse clinical presentations, necessitating systematic risk assessment for deterioration.
  • The predictive accuracy of existing mortality predictors in pediatric emergency departments (PEDs) requires thorough evaluation.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of various mortality predictors in PEDs.
  • To assess metrics including sensitivity, specificity, and diagnostic odds ratio for these predictors.

Main Methods:

  • A systematic search of multiple databases was conducted for cohort studies, case-control studies, and RCTs from 2000-2024.
  • Studies included pediatric patients (0-18 years) presenting to PEDs, analyzing mortality predictors for in-ED and short-term post-ED mortality.
  • Bivariate random-effects modeling was used to calculate pooled sensitivity, specificity, DOR, and AUC.

Main Results:

  • Analysis of 329 Pediatric Early Warning Score (PEWS) thresholds revealed an optimal cutoff of 2.189 (AUC=0.70) with high pooled sensitivity (0.95) and specificity (0.93).
  • Strong negative predictive value (NPV=0.0006) and modest positive predictive value (PPV=0.0003) were observed.
  • Significant heterogeneity (I²>99%) was noted, influenced by PEWS versions and settings; however, PEWS implementation reduced mortality without increasing ICU admissions in resource-limited settings.

Conclusions:

  • The Pediatric Early Warning Score (PEWS) serves as an effective tool for excluding low-risk pediatric patients.
  • A comprehensive approach integrating clinical judgment is crucial for accurate risk assessment in high-risk pediatric patients.
Abstract

Keywords:
Clinical predictorsDiagnostic accuracyEarly warning scoresEmergency departmentPediatric mortality predictorsRisk stratification

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