Vital signs as biomarkers of early clinical
deterioration in pediatric emergency
departments: physiology, interpretation,
and innovations: a narrative review

Vital signs as biomarkers of early clinical
deterioration in pediatric emergency
departments: physiology, interpretation,
and innovations: a narrative review

Pediatrics, Vital signs, Emergency, EHR-embedded alerts, Continuous surveillance, Wearable sensors

Abstract
Background Early recognition of pediatric deterioration is difficult because age-dependent physiology and
compensation mask early shock and safety risks. This narrative review compares vital-sign (VS) biomarkers (heart rate,
respiratory rate, blood pressure, oxygen saturation, temperature) with laboratory markers and clinical indicators.
Methods We searched Embase, Pubmed, and guideline repositories to August 2025 for pediatric studies from
emergency, inpatient, and critical-care settings. We summarized accuracy, timeliness, and implementation issues,
prioritizing cohort and implementation evaluations.
Results Age-adjusted, repeated, and continuous analyses of VS—especially multivariate approaches such as
shock index pediatric age-adjusted and heart-rate-characteristics analytics—outperformed single thresholds,
often anticipating ICU transfer or sepsis by hours. Laboratory biomarkers provided diagnostic specificity for defined
syndromes but were slower and unsuitable for continuous surveillance. Composite scores (e.g., PEWS, ED-PEWS,
National PEWS) showed moderate to high discrimination yet performed best when integrated with trends and
standardized escalation pathways.
Conclusion VS biomarkers, leveraged as dynamic trends and combined with context, enable earlier, safer detection
of pediatric deterioration than static thresholds or isolated laboratory tests. Priorities include validating continuous
models beyond NICUs, ensuring equity and calibration across different ages and comorbidities, and testing wearable

sensors and EHR-embedded alerts in pragmatic trials that measure timeliness, unintended harms, and patient-
centered outcomes.

Clinical trial number Not applicable.
Keywords Pediatrics, Vital signs, Emergency, EHR-embedded alerts, Continuous surveillance, Wearable sensors

Mohamed Alsabri1*, Marina Ramzy Mourid2

, Amr R. Saleh3

, Temitomi Jane Oyedele4

, Israa Magdy Ata5
,

Sara M. Darawish6

, Aanal Patel7

, Faher AL Rouh2

and Lauren A. Carr8

https://doi.org/10.1186/s12245-025-01107-8

2026

peri irawan

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