Pediatric Early Warning System (PEWS) Association with ICU Mortality in Children with Acute Lymphoblastic Leukemia: A Cohort Study from Kazakhstan
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Summary
This summary is machine-generated.Pediatric Early Warning System (PEWS) monitoring did not improve survival for critically ill children with acute lymphoblastic leukemia (ALL) in Kazakhstan. Inflammatory and cardiorespiratory issues were more strongly linked to mortality than PEWS alerts.
Area Of Science
- Pediatric critical care medicine
- Hematology-oncology
- Public health in middle-income countries
Background
- Childhood acute lymphoblastic leukemia (ALL) presents significant morbidity and mortality, especially in middle-income nations.
- The Pediatric Early Warning System (PEWS) aims to improve care escalation for critically ill children.
- The independent impact of PEWS on survival in pediatric ALL patients in Kazakhstan and Central Asia remains underexplored.
Purpose Of The Study
- To evaluate the independent effect of implementing 24-hour PEWS monitoring on intensive care unit (ICU) mortality among children with ALL.
- To identify key factors associated with ICU mortality in this high-acuity pediatric population.
Main Methods
- Retrospective review of ICU admissions for pediatric ALL patients (0-18 years) across pre- and post-PEWS implementation periods.
- Data collection included demographic, clinical, transfusion, vital signs, symptoms, laboratory, and instrumental data.
- Univariable and multivariable logistic regression analyses were performed to determine associations with ICU mortality.
Main Results
- Overall ICU mortality was 21.7% across 255 admissions.
- PEWS implementation showed no statistically significant association with reduced ICU mortality (AOR 0.89), despite lower unadjusted mortality post-implementation.
- Bilateral pneumonia (AOR 7.45), frequent hyperthermia (AOR 5.42), and systemic inflammatory response syndrome (AOR 4.61) were strongly associated with mortality.
Conclusions
- In critically ill pediatric ALL patients, inflammatory and cardiorespiratory derangements appear to be more critical determinants of survival than ward-based PEWS surveillance alone.
- Improving outcomes necessitates integrating early warning systems with prompt deterioration management, targeted cardiopulmonary support, and context-specific resource allocation.
- Sole reliance on surveillance scores may not be sufficient; a comprehensive approach to managing critically ill children with ALL is required.