Background: Pediatric Early Warning Scores (PEWS) are physiologically-based scoring systems developed to identify patients admitted to inpatients pediatric wards and emergency departments. Objective: Our study objective was to explore if the PEWS assigned in the ED or ward predicts the need for ICU admission from the ED or clinical deterioration in admitted patients. Patients and Methods: This retrospective study was carried out at the Pediatric Intensive Care Units of Zagazig University Hospitals on 53 children admitted to Pediatric Intensive Care Units (PICUs) in the period from June 2017 to June 2018. PEWS scores were measured at initial assessment (H0) and time of admission (H1). Results: We evaluated 12 different PEWS and the ability to predict early deterioration and the need to ICU admission. We also reported that ward has the highest percentage in admission by 60.4% to ICU, then emergency room by 39.6%. The patients included 32 (60%) males and 21 (40%) females with mean age 17.42 ± 28.002 months. Pneumonia had the highest percentage by 32.1%, and then fulminant hepatic failure comes in second place by 22.6%, followed by sepsis 13.2%. Mean duration length of staying in hospital before admission to PICU was 2.05 ± 2.89 days, and the mean after admission to PICU was 5.16 ± 6.69 days. Patients admitted from ward were statistically higher in hospital stay before admission to PICU. Conclusion: pediatric early warning score can be helpful in predicting patient disposition in pediatric emergency department (ED) with acceptable validity and can serve as a potentially excellent screening tool for prediction of ICU admission.