Journal article
Mortality predictors in pediatric emergency department presentations: a systematic review and meta-analysis
BMC emergency medicine, v 25(1), 188
26 Sep 2025
PMID: 41013297
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
BackgroundPediatric patients present to the emergency departments (EDs) with a wide range of clinical manifestations, ranging from mild to severe. A systematic approach is crucial to identify those at high risk of deterioration. However, the predictive value of such predictors remains unclear. ObjectivesOur study aims to evaluate different mortality predictors used in pediatric emergency departments (PEDs) regarding the diagnostic accuracy metrics, including sensitivity, specificity, and diagnostic odds ratio. MethodsWe comprehensively searched multiple databases and included all cohort studies, case-control studies, and randomized controlled trials from January 2000 to December 2024 with pediatric patients (aged 0-18 years) presenting to PEDs, where mortality predictors were used to assess for in-ED and short-term post-ED mortality. We employed a bivariate random-effects model for data synthesis and analysis to calculate pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) values. Results329 Pediatric Early Warning Score (PEWS) thresholds were analyzed, with the model-derived optimal cutoff 2.189 (AUC) = 0.70; 95% CI: 0.63 to 0.76), high pooled sensitivity (0.95, 95% CI: 0.72 to 0.80) and specificity (0.93, 95% CI: 0.62 to 0.80). In addition, A strong negative predictive value (NPV = 0.0006) and modest positive predictive value (PPV = 0.0003) were noted. Heterogeneity was significant (I-2>99%), driven by PEWS versions and clinical settings. PEWS implementation reduced mortality without increasing ICU admissions in resource-limited settings. ConclusionsPEWS is a good exclusion tool for those at low mortality risk. However, a comprehensive approach with clinical judgment is needed for the risk assessment of high-risk pediatrics.
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Details
- Title
- Mortality predictors in pediatric emergency department presentations: a systematic review and meta-analysis
- Creators
- Mohammed Alsabri (Corresponding Author) - Drexel University, College of MedicineMohamed A. Elkarargy - Alexandria UniversityIsraa Magdy Ata - Menoufia UniversityMostafa A. Khalifa - Cairo UniversityAbdulrahman Khaldoon Hamid - Jordan HospitalAhmed Bostamy Elsnhory - Al-Azhar UniversityOmar Ahmed Abdelwahab - Al-Azhar UniversitySarah Urbon - St. Christopher's Hospital for Children
- Publication Details
- BMC emergency medicine, v 25(1), 188
- Publisher
- Springer Nature
- Number of pages
- 15
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:001582376300001
- Scopus ID
- 2-s2.0-105017414361
- Other Identifier
- 991022197400804721
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- Collaboration types
- International collaboration
- Web of Science research areas
- Emergency Medicine