Abstract: As the initial site of care for pediatric emergencies and critical illness，the outpatient and emergency department plays a decisive role in patient outcomes，with assessment performance directly influencing prognosis. In high-demand clinical settings，the combination of insidious disease onset and limited physiological reserve in children complicates early risk recognition. Emergency assessment should therefore be conceptualized as a continuous process spanning prehospital management，transport，and inhospital evaluation rather than an isolated in-hospital task. Despite substantial progress in pediatric emergency system development，further integration between prehospital and inhospital assessment—particularly in unified risk frameworks and continuity of dynamic monitoring—is warranted. This paper reviews current practices and emphasizes physiology-centered clinical reasoning and dynamic reassessment as key strategies for detecting occult critical illness，with the goal of strengthening anticipatory risk appraisal and enhancing the resilience of the pediatric emergency care continuum.

Key words: pediatric critical illness, early recognition, dynamic reassessment, pre-hospital and hospital linkage

摘要： 门急诊作为儿科急危重症救治的起始环节，其评估效能直接影响患儿预后。当前，儿科诊疗环境负荷高、患儿病理生理代偿有限且病情变化迅速、起病隐匿，给早期精准评估带来客观挑战。笔者认为，门急诊评估并非孤立的院内行为，而应被视为贯穿院前处置、专业转运至院内接诊的连续思维链条。尽管我国儿科急救体系建设取得长足进步，但院前与院内在评估视角的统一性、动态监测的连续性等方面仍有协同空间。文章通过分析门急诊评估现状，探讨如何强化以“生理功能”为核心的临床思维，强调动态复评在识别隐匿性危重症中的决策价值，力求提升医护人员的风险预判能力与思维深度，从而优化急诊决策，为构建更具韧性的儿科急救链条提供思路借鉴。

关键词: 儿童危重症, 早期识别, 动态复评, 院前 - 院内衔接