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Objectives: Early warning scores (EWS) alerting for in-hospital deterioration are commonly developed using routinely collected vital-sign data from the whole in-hospital population. As these in-hospital populations are dominated by those over the age of 45 years, resultant scores may perform less well in younger age groups. We developed and validated an age-specific early warning score (ASEWS) derived from statistical distributions of vital signs., Design: Observational cohort study., Setting: Oxford University Hospitals (OUH) July 2013 to March 2018 and Portsmouth Hospitals (PH) NHS Trust January 2010 to March 2017 within the Hospital Alerting Via Electronic Noticeboard database., Participants: Hospitalised patients with electronically documented vital-sign observations OUTCOME: Composite outcome of unplanned intensive care unit admission, mortality and cardiac arrest., Methods and Results: Statistical distributions of vital signs were used to develop an ASEWS to predict the composite outcome within 24 hours. The OUH development set consisted of 2 538 099 vital-sign observation sets from 142 806 admissions (mean age (SD): 59.8 (20.3)). We compared the performance of ASEWS to the National Early Warning Score (NEWS) and our previous EWS (MCEWS) on an OUH validation set consisting of 581 571 observation sets from 25 407 emergency admissions (mean age (SD): 63.0 (21.4)) and a PH validation set consisting of 5 865 997 observation sets from 233 632 emergency admissions (mean age (SD): 64.3 (21.1)). ASEWS performed better in the 16-45 years age group in the OUH validation set (AUROC 0.820 (95% CI 0.815 to 0.824)) and PH validation set (AUROC 0.840 (95% CI 0.839 to 0.841)) than NEWS (AUROC 0.763 (95% CI 0.758 to 0.768) and AUROC 0.836 (95% CI 0.835 to 0.838) respectively) and MCEWS (AUROC 0.808 (95% CI 0.803 to 0.812) and AUROC 0.833 (95% CI 0.831 to 0.834) respectively). Differences in performance were not consistent in the elder age group., Conclusions: Accounting for age-related vital sign changes can more accurately detect deterioration in younger patients., Competing Interests: Competing interests: LT and Peter Watkinson co-developed the System for Electronic Notification and Documentation (SEND), for which Sensyne Health (SH) has purchased a sole license. SH has a research agreement with the University of Oxford and royalty agreements with Oxford University Hospitals NHS Trust and the University of Oxford. SH paid LT consultancy fees as a member of its Strategic Advisory Board. PJW is the Chief Medical Officer and holds shares in the company. His department has received funding from SH. DAC is the Research Director at SH. DP was an employee of Portsmouth NHS Trust until July 2016 and he assisted the Royal College of Physicians of London in the analysis of data validating NEWS., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)