Background: Pediatric Early Warning signs (PEWS) Scores are widely used tool for identifying early signs of deterioration in critically ill pediatrics patients and also provide a structured process for the reassessment and escalation of care which can help in prevention of a serious life-threatening event. Objectives: To evaluate the utility of the PEWSscoring system in predicting need for critical care admission of pediatric patients visiting emergency room (ER) in our hospital. Methods: A total of 280 children with fever visiting the ER of Department of Pediatrics during the study period were enrolled. Vitals and detailed physical examination were done as per the hospital protocol. PEWS score calculated using Brighton charts and documented along with patient records and proforma. PEWS used for prediction of ICU admission of the patients. Results:PEWS scores in the study children ranged from 0 to 10. The median age of children was 4.2 years; most of them (55%) were boys. Statistically significant difference (p<0.05) was found between PEWS score of patients admitted to the PICU and PEWS score of patients who didn’t require PICU admission. The mean respiratory rate were significant differ (p<0.05) of patients needing PICU as compared to those who didn’t need PICU.There is a significant difference in all the vital parameters between patients needing PICU and those who didn’t need PICU. The PEWS score of 3, the sensitivity was 81% specificity was 76.8%, PPV was 22.1% and NPV was 98%. The implication of this finding is that if a child in ER has a score of <3, chances of PICU admission in the next 24 hours are less as compared to PEWS score ≥ 7. Conclusion: PEWS is a best useful tool to predict critical care requirement, clinical deterioration, length of hospital stay and mortality in pediatric patients.