Evaluation of early warning scores in predicting clinical deterioration among hospitalized pediatric patients

Submission: 01 November 2025 | Acceptance: 20 January 2026 | Publication: 07 April 2026

¹Dr Babar Shahzad, ²Waqas Ali, ³Dr Faiza Maqsood, ⁴Dr Qasim Raza, ⁵Dr Umar Tipu, ⁶Dr Mansoor Musa

¹Associate Professor, PIMS Islamabad

²Associate Professor, Ghurki Trust Teaching Hospital

³Assistant Professor, Bolan Medical College, Quetta

⁴Assistant Professor, PIMS Islamabad

⁵Assistant Professor, Shifa International Hospital, Islamabad

⁶Assistant Professor, Poonch Medical College, CMH Rawlakot

ABSTRACT:

Background: Early recognition of clinical deterioration in hospitalized pediatric patients had remained a critical component of improving outcomes and reducing morbidity and mortality. Early Warning Scores (EWS) had been widely implemented in various healthcare settings to identify at-risk patients; however, their predictive accuracy in pediatric populations, particularly within local clinical environments, had required further evaluation. Understanding the effectiveness of these scoring tools had been essential for timely interventions and improved patient safety.

Aim: The aim of this study had been to evaluate the predictive accuracy and clinical utility of pediatric early warning scores in identifying clinical deterioration among hospitalized pediatric patients at PIMS, Islamabad.

Methods: This observational study had been conducted at the Pediatric Department of PIMS Islamabad from October 2024 to September 2025. The study population had consisted of 90 hospitalized pediatric patients aged 1 month to 14 years. Standardized early warning score parameters—including respiratory rate, oxygen saturation, heart rate, temperature, level of consciousness, and overall clinical appearance—had been assessed at admission and subsequently at regular intervals. Clinical deterioration had been defined as the need for unplanned transfer to the pediatric intensive care unit (PICU), initiation of advanced respiratory support, cardiopulmonary arrest, or mortality. Data had been analyzed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) curve assessments to determine the predictive validity of EWS.

Results: The study findings had demonstrated that higher early warning scores at initial assessment had been strongly associated with subsequent clinical deterioration. The EWS had shown good sensitivity and moderate specificity in predicting the need for PICU transfer. ROC curve analysis had indicated that the tool possessed strong overall accuracy, with the area under the curve falling within an acceptable predictive range. Patients who had deteriorated clinically had consistently displayed elevated scores several hours before adverse events, supporting the usefulness of EWS as an early detection tool.

Conclusion: The study had concluded that pediatric early warning scores had been effective in predicting clinical deterioration among hospitalized children at PIMS Islamabad. Their consistent ability to identify high-risk patients prior to adverse outcomes had emphasized their value in routine pediatric care. Incorporating EWS into clinical workflows had the potential to enhance early intervention, reduce preventable complications, and improve patient outcomes.

Keywords: Pediatric Early Warning Scores, Clinical Deterioration, Hospitalized Children, Predictive Accuracy, PIMS Islamabad, Patient Safety.