<![CDATA[Changes in children's health status in the Emergency Department (ED) often occur suddenly, progressively, and are difficult to recognize due to children's limited verbal communication and non-specific clinical manifestations. This condition triggers a high risk of triage errors (mistriage), especially in general EDs, leading to delayed treatment and increased mortality. The Pediatric Early Warning Score (PEWS) assessment system has the potential to be a structured solution to improve assessment accuracy through objective monitoring of physiological parameters. This study aims to evaluate the effectiveness of implementing PEWS in improving triage accuracy for pediatric patients in the emergency department through a systematic review. This study employed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted across the PubMed, Scopus, ScienceDirect, Cochrane Library, and ProQuest databases for articles published between 2021 and 2025. The search strategy combined Medical Subject Headings (MeSH) terms and keywords, including "Pediatric Early Warning Score" OR "PEWS" AND "pediatric triage" OR "emergency department" OR "clinical deterioration" OR "early detection" OR "hospital admission" OR "critical care" OR "pediatric emergency". Articles were selected according to predefined inclusion criteria, and their methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. A total of 17 articles were included in the review. The findings demonstrated that the implementation of the Pediatric Early Warning Score (PEWS) enhances the early detection of clinical deterioration in pediatric patients and improves triage accuracy in emergency departments. Most studies reported that PEWS has good sensitivity and specificity for predicting the need for critical care admission, thereby facilitating faster and more accurate clinical decision-making. Furthermore, the use of PEWS improves communication among healthcare professionals and enhances pediatric patient safety.]]>
