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Accuracy of Bedside Paediatric Early Warning System (BedsidePEWS) in a Pediatric Stem Cell Transplant Unit
Orsola Gawronski1, Marta L Ciofi Degli Atti2, Vincenzo Di Ciommo2
1University of Tor Vergata, Rome, Italy Bambino Gesù Children's Hospital IRCCS, Rome, Italy orsola.gawronski@opbg.net.
Insights
The bedside pediatric early warning system (BedsidePEWS) accurately predicts clinical deterioration in pediatric stem cell transplant (SCT) patients. This early warning score can help identify at-risk children, potentially improving outcomes in SCT units.
Area of Science:
- Pediatric critical care medicine
- Hematology and oncology
- Translational medicine
Background:
- Hospital mortality remains high for children undergoing stem cell transplant (SCT).
- Early warning scores are crucial for early detection of patient deterioration and prevention of adverse events.
- The bedside pediatric early warning system (BedsidePEWS) is a validated scoring system for pediatric patients.
Purpose of the Study:
- To evaluate the effectiveness of the BedsidePEWS in identifying clinical deterioration in pediatric SCT patients.
- To assess the performance of BedsidePEWS in predicting adverse events in a high-risk pediatric population.
- To determine the utility of BedsidePEWS as a screening tool in SCT units.
Main Methods:
- A case-control study design was employed.
- Clinical deterioration events in pediatric SCT patients were identified as cases.
- BedsidePEWS scores were retrospectively collected at 4-hour intervals for 24 hours preceding an event (T4-T24) in both cases and controls.
Main Results:
- The study included 19 cases and 80 controls.
- BedsidePEWS scores significantly increased in cases from T24 (median 4) to T4 (median 14) prior to deterioration.
- The model demonstrated high accuracy, with over 90% correct classification of cases and controls from T8 onwards.
- The area under the curve (AUC) for the receiver operating characteristic (ROC) curve was 0.9, indicating excellent predictive performance.
Conclusions:
- BedsidePEWS is a highly accurate and reliable screening tool for predicting clinical deterioration in pediatric SCT patients.
- Early identification of deteriorating patients using BedsidePEWS can facilitate timely interventions and potentially improve patient outcomes.
- The findings support the implementation of BedsidePEWS in SCT units for enhanced patient monitoring and safety.
Abstract:
Hospital mortality in children who undergo stem cell transplant (SCT) is high. Early warning scores aim at identifying deteriorating patients and at preventing adverse outcomes. The bedside pediatric early warning system (BedsidePEWS) is a pediatric early warning score based on 7 clinical indicators, ranging from 0 (all indicators within normal ranges for age) to 26. The aim of this case-control study was to assess the performance of BedsidePEWS in identifying clinical deterioration events among children admitted to an SCT unit. Cases were defined as clinical deterioration events; controls were all the other patients hospitalized on the same ward at the time of case occurrence. BedsidePEWS was retrospectively measured at 4-hour intervals in cases and controls 24 hours before an event (T4-T24). We studied 19 cases and 80 controls. The score significantly increased in cases from a median of 4 at T24 to a median of 14 at T4. The proportion of correctly classified cases and controls was >90% since T8. The area under the curve receiver operating characteristic was 0.9. BedsidePEWS is an accurate screening tool to predict clinical deterioration in SCT patients.
