Abstract / Summary
Background/Objectives: Early recognition of children with severe physiological illness is essential in emergency care. The Emergency Department Pediatric Early Warning System score (ED-PEWS) has not been evaluated in Vietnam. We assessed how well ED-PEWS recorded at presentation identifies children who meet criteria for resuscitation-defined critical illness in a high-acuity pediatric emergency setting. Methods: This prospective observational diagnostic classification study was conducted from August to October 2022 in the emergency and resuscitation department of a national tertiary children’s hospital in Vietnam. Children aged 1 month to 15 years were enrolled according to a prespecified shift-based schedule. The outcome was resuscitation-defined critical illness within 24 h (cardiac arrest or bradycardia with poor perfusion requiring cardiopulmonary resuscitation). Because the timing of scoring relative to interventions and outcome was not recorded, the analysis was interpreted as concurrent classification rather than prediction. Results: Of 805 children (median age 19 months; 65.3% male), 156 (19.4%) met the outcome criteria. The median ED-PEWS was 32 (interquartile range, 24–43) in children with the outcome and 10 (8–12) in those without (p < 0.001). The area under the receiver operating characteristic curve was 0.952 (95% CI, 0.926–0.977). At the exploratory Youden-derived threshold of ED-PEWS ≥ 16, there were 143 true positives, 49 false positives, 13 false negatives, and 600 true negatives; sensitivity was 91.7% (95% CI, 86.2–95.5), specificity 92.4% (90.1–94.4), and negative predictive value 97.9% (96.4–98.9). Conclusions: In this selected high-acuity cohort, ED-PEWS showed strong concurrent discrimination for resuscitation-defined critical illness. Because the score and the outcome share physiological components and the threshold was derived and evaluated in the same dataset, these findings are exploratory and require multicenter external validation and comparison with existing triage systems.