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Predicting Clinical Deterioration in Pediatric Hematology-Oncology Patients: PEWS Scales-A Scoping Review
Simona Calza1, Matilde Gabrieli1, Stefano Parodi2
1Health Professionals Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Insights
Pediatric Early Warning Scores (PEWS) effectively identify clinical deterioration in pediatric cancer patients. These scores predict unplanned intensive care unit transfers, aiding timely interventions for better outcomes.
Area of Science:
- Pediatric Oncology
- Critical Care Medicine
- Clinical Informatics
Background:
- Pediatric tumors present significant risks, necessitating early detection of clinical deterioration.
- Pediatric Early Warning Scores (PEWS) are vital tools for timely intervention and improved patient prognosis.
- Evaluating PEWS accuracy in hemato-oncological patients is crucial for optimizing care.
Purpose of the Study:
- To assess the predictive accuracy of major PEWS in pediatric hemato-oncological patients.
- To determine the effectiveness of PEWS in early recognition of clinical deterioration.
- To evaluate PEWS's ability to predict unplanned pediatric intensive care unit (PICU) transfers.
Main Methods:
- A scoping review of studies published between 2013 and 2023 was conducted.
- Searches included PubMed, CINAHL, Scopus, and Web of Science for relevant English-language studies.
- Seven studies evaluating PEWS impact on clinical deterioration and PICU transfers were included.
Main Results:
- Several PEWS, including Bedside PEWS, CHEWS, and Modified Brighton PEWS, demonstrated high predictive accuracy (AUCs 0.91-0.95).
- Elevated PEWS scores within 24 hours predicted the need for unplanned PICU transfers.
- The reviewed PEWS showed good ability in detecting clinical deterioration.
Conclusions:
- PEWS are essential for early identification of clinical deterioration in pediatric hemato-oncology.
- Current PEWS demonstrate promising predictive capabilities for critical events and PICU transfers.
- Further large-scale, prospective research is needed to validate and refine PEWS in diverse pediatric oncology populations.
Abstract:
IntroductionPediatric tumors pose significant morbidity and mortality risks. Clinical deterioration is recurrent, requiring timely interventions. Pediatric Early Warning Score (PEWS) is crucial for early recognition and timely intervention, improving patient prognosis. This study evaluates the predictive accuracy of major PEWS in pediatric hemato-oncological patients for identifying early recognition of clinical deterioration and predicting unplanned pediatric intensive care unit (PICU) transfers.MethodA scoping review identifying primary studies published between 2013 and 2023 on PEWS in pediatric hemato-oncological patients was performed. Searches were conducted in PubMed, CINAHL, Scopus, and Web of Science. Inclusion criteria were English-language studies evaluating PEWS's impact on recognizing clinical deterioration and unplanned PICU transfers.ResultsOut of 3,084 studies initially identified, 7 were included in the review. Bedside Pediatric Early Warning System (Bedside PEWS), Modified Bedside PEWS, Children's Hospital Early Warning Score (CHEWS), and Modified Brighton Pediatric Early Warning Score (Brighton PEWS) showed good predictive ability in detecting clinical deterioration. The area under the receiver operating characteristic curve was 0.93 for Bedside PEWS, 0.95 for CHEWS, and 0.91 for Modified Brighton PEWS, indicating high predictive accuracy. Increased scores within 24 hr before a critical event predicted the need for unplanned PICU transfer.ConclusionWhile PEWS are essential for early identification of clinical deterioration in pediatric patients with hematological and oncological conditions, these systems show promising predictive capability. Further large-scale, prospective, and comparative research is needed to validate these findings across different population conditions and treatments, allowing for an evolution of our understanding in this field.
