Medical Journal of the Islamic Republic Of Iran

en The Role of Pediatric Early Warning Scores (PEWS) in Determining PICU Transfer Necessity and Length of Stay Pediatric Pediatric Original Research Original Research Background: Early identification of clinical deterioration in hospitalized children remains a major challenge, particularly in determining the need for Pediatric Intensive Care Unit (PICU) transfer. Pediatric Early Warning Scores (PEWS) have been proposed as a tool to support clinical decision-making. This study aimed to evaluate the association between PEWS and PICU transfer, as well as patient outcomes in hospitalized children.    Methods: This cross-sectional study included all children hospitalized in the wards or referred to the emergency department of Aliasghar Hospital who required a PICU consultation from September 2023 to February 2024. A pediatrician independently completed the PEWS for each child before the PICU consultation. The outcomes measured were transfer to the PICU, length of stay (LOS) in the PICU, duration of ward hospitalization, and mortality. Statistical analyses included Pearson correlation, Chi-square test, and post hoc Least Significant Difference (LSD) test. Multivariate logistic regression models were constructed to assess the independent effect of PEWS on PICU transfer, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Model performance was evaluated using receiver operating characteristic (ROC) curve analysis.    Results: A total of 169 children were included (mean (SD) age: 5.00 (4.65) years; 103 [60.9%] male). The mean (SD) LOS was 4.42 (3.97) days in the ward and 8.54 (6.98) days in the PICU. The mean PEWS was 6.90 (2.22), with 112 (66.3%) patients classified as red and 9 (5.3%) as green. Nine patients (9/169, 5.3%), all in the red category, died during hospitalization. Higher PEWS scores were significantly associated with increased odds of PICU transfer (OR = 3.17, 95% CI: 1.79–5.63, P < 0.001). Transfer rates increased across PEWS categories, reaching 100% in the red group. Significant differences in PICU LOS were observed across PEWS severity groups, with patients in the red category having longer stays.    Conclusion: PEWS is a valuable tool for early detection of deterioration, but should not be used alone for PICU transfer decisions. Clinical context, underlying diagnoses, and ongoing assessment must be considered alongside PEWS scores for effective patient management.   Pediatric Early Warning score, PEWS, Pediatric Intensive Care Unit, Pediatrics 603 610 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-9872-1&slc_lang=en&sid=1 Neda Ashayeri neda_ashayeri@yahoo.com 200319475328460098713 200319475328460098713 No Department of Pediatrics, School of Medicine, Aliasghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran Motahareh Aghajani Delavar aghajani_14@yahoo.com 200319475328460098714 200319475328460098714 No Department of Pediatrics, School of Medicine, Aliasghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran Elahe Hosseini elahehosseinisalekdeh@gmail.com 200319475328460098715 200319475328460098715 Yes Department of Pediatrics, School of Medicine, Aliasghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran Azar Mohammadzadeh mohammadzadehazar@gmail.com 200319475328460098716 200319475328460098716 No Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran Arash Mohazzab amohazzab@yahoo.com 200319475328460098717 200319475328460098717 No School of Public Health, Iran University of Medical Sciences, Tehran, Iran Atefeh Velayati atefehvelayati1@gmail.com 200319475328460098718 200319475328460098718 No Department of Pediatrics, School of Medicine, Aliasghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran