Objectives: To assess the predictive value of Pediatric Early Warning Scores (PEWS) for identifying respiratory deterioration in children presenting to the emergency department. Methods: A thorough search across four databases identified 455 relevant publications. After removing duplicates using Rayyan QCRI and screening for relevance, 36 full-text articles were reviewed, with 5 studies ultimately meeting the criteria for inclusion. Results: We included five studies with a total of 155,836 children and 87,424 (56.1%) were males. PEWS has been demonstrated to significantly enhance clinical outcomes by enabling early recognition of patient deterioration, allowing for preemptive action. It has shown potential as a predictive tool for hospitalization, particularly in identifying children at risk of severe outcomes. PEWS also aids clinicians in prioritizing patient care, escalating care more effectively, and making informed decisions regarding the need for intensive monitoring or transfer to specialized care units. Conclusion: PEWS is a valuable tool in pediatric emergency and critical care, with significant potential to improve patient outcomes by facilitating the early detection of deterioration. However, to maximize its benefits, PEWS should be integrated into a broader clinical assessment and decision-making framework, complemented by other diagnostic indicators and clinical judgments. Future research should focus on refining the scoring system to enhance its sensitivity and specificity, tailoring its application to effectively address different pediatric conditions.