Asya Agulnik1,2, Alejandra Méndez Aceituno3, Lupe Nataly Mora Robles4, Peter W Forbes5, Dora Judith Soberanis Vasquez6, Ricardo Mack3,7, Federico Antillon-Klussmann6,7, Monica Kleinman8, Carlos Rodriguez-Galindo1. 1. Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee. 2. Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee. 3. Pediatric Critical Care, Unidad Nacional de Oncología Pediátrica Unit, Guatemala City, Guatemala. 4. Pediatric Critical Care, Sociedad de Lucha Contra el Cáncer, Cuenca City, Ecuador. 5. Clinical Research Program, Boston Children's Hospital, Boston, Massachusetts. 6. Hematology/Oncology, Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala. 7. Francisco Marroquin University School of Medicine, Guatemala City, Guatemala. 8. Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts.
Abstract
BACKGROUND: Pediatric oncology patients are at high risk of clinical deterioration, particularly in hospitals with resource limitations. The performance of pediatric early warning systems (PEWS) to identify deterioration has not been assessed in these settings. This study evaluates the validity of PEWS to predict the need for unplanned transfer to the pediatric intensive care unit (PICU) among pediatric oncology patients in a resource-limited hospital. METHODS: A retrospective case-control study comparing the highest documented and corrected PEWS score before unplanned PICU transfer in pediatric oncology patients (129 cases) with matched controls (those not requiring PICU care) was performed. RESULTS: Documented and corrected PEWS scores were found to be highly correlated with the need for PICU transfer (area under the receiver operating characteristic, 0.940 and 0.930, respectively). PEWS scores increased 24 hours prior to unplanned transfer (P = .0006). In cases, organ dysfunction at the time of PICU admission correlated with maximum PEWS score (correlation coefficient, 0.26; P = .003), patients with PEWS results ≥4 had a higher Pediatric Index of Mortality 2 (PIM2) (P = .028), and PEWS results were higher in patients with septic shock (P = .01). The PICU mortality rate was 17.1%; nonsurvivors had higher mean PEWS scores before PICU transfer (P = .0009). A single-point increase in the PEWS score increased the odds of mechanical ventilation or vasopressors within the first 24 hours and during PICU admission (odds ratio 1.3-1.4). CONCLUSIONS: PEWS accurately predicted the need for unplanned PICU transfer in pediatric oncology patients in this resource-limited setting, with abnormal results beginning 24 hours before PICU admission and higher scores predicting the severity of illness at the time of PICU admission, need for PICU interventions, and mortality. These results demonstrate that PEWS aid in the identification of clinical deterioration in this high-risk population, regardless of a hospital's resource-level. Cancer 2017;123:4903-13.
BACKGROUND: Pediatric oncology patients are at high risk of clinical deterioration, particularly in hospitals with resource limitations. The performance of pediatric early warning systems (PEWS) to identify deterioration has not been assessed in these settings. This study evaluates the validity of PEWS to predict the need for unplanned transfer to the pediatric intensive care unit (PICU) among pediatric oncology patients in a resource-limited hospital. METHODS: A retrospective case-control study comparing the highest documented and corrected PEWS score before unplanned PICU transfer in pediatric oncology patients (129 cases) with matched controls (those not requiring PICU care) was performed. RESULTS: Documented and corrected PEWS scores were found to be highly correlated with the need for PICU transfer (area under the receiver operating characteristic, 0.940 and 0.930, respectively). PEWS scores increased 24 hours prior to unplanned transfer (P = .0006). In cases, organ dysfunction at the time of PICU admission correlated with maximum PEWS score (correlation coefficient, 0.26; P = .003), patients with PEWS results ≥4 had a higher Pediatric Index of Mortality 2 (PIM2) (P = .028), and PEWS results were higher in patients with septic shock (P = .01). The PICU mortality rate was 17.1%; nonsurvivors had higher mean PEWS scores before PICU transfer (P = .0009). A single-point increase in the PEWS score increased the odds of mechanical ventilation or vasopressors within the first 24 hours and during PICU admission (odds ratio 1.3-1.4). CONCLUSIONS: PEWS accurately predicted the need for unplanned PICU transfer in pediatric oncology patients in this resource-limited setting, with abnormal results beginning 24 hours before PICU admission and higher scores predicting the severity of illness at the time of PICU admission, need for PICU interventions, and mortality. These results demonstrate that PEWS aid in the identification of clinical deterioration in this high-risk population, regardless of a hospital's resource-level. Cancer 2017;123:4903-13.
Authors: Marijn Soeteman; Teus H Kappen; Martine van Engelen; Ellen Kilsdonk; Erik Koomen; Edward E S Nieuwenhuis; Wim J E Tissing; Marta Fiocco; Marry van den Heuvel-Eibrink; Roelie M Wösten-van Asperen Journal: BMJ Open Date: 2021-05-19 Impact factor: 2.692
Authors: Rob Trubey; Chao Huang; Fiona V Lugg-Widger; Kerenza Hood; Davina Allen; Dawn Edwards; David Lacy; Amy Lloyd; Mala Mann; Brendan Mason; Alison Oliver; Damian Roland; Gerri Sefton; Richard Skone; Emma Thomas-Jones; Lyvonne N Tume; Colin Powell Journal: BMJ Open Date: 2019-05-05 Impact factor: 2.692
Authors: Dylan E Graetz; Emily Giannars; Erica C Kaye; Marcela Garza; Gia Ferrara; Mario Rodriguez; Dora Judith Soberanis Vasquez; Alejandra Mendez Aceituno; Federico Antillon-Klussmann; Jami S Gattuso; Karen L Andes; Belinda N Mandrell; Justin N Baker; Carlos Rodriguez-Galindo; Asya Agulnik Journal: Front Oncol Date: 2021-02-25 Impact factor: 6.244
Authors: Asya Agulnik; Sara Malone; Maria Puerto-Torres; Alejandra Gonzalez-Ruiz; Yuvanesh Vedaraju; Huiqi Wang; Dylan Graetz; Kim Prewitt; Cesar Villegas; Adolfo Cardenas-Aguierre; Carlos Acuna; Ana Edith Arana; Rosdali Díaz; Silvana Espinoza; Karla Guerrero; Angélica Martínez; Alejandra Mendez; Erika Montalvo; Dora Soberanis; Antonella Torelli; Janeth Quelal; Erika Villanueva; Meenakshi Devidas; Douglas Luke; Virginia McKay Journal: BMJ Open Date: 2021-10-20 Impact factor: 3.006
Authors: Dylan Graetz; Erica C Kaye; Marcela Garza; Gia Ferrara; Mario Rodriguez; Dora Judith Soberanis Vásquez; Alejandra Méndez Aceituno; Federico Antillon-Klussmann; Jami S Gattuso; Belinda N Mandrell; Justin N Baker; Carlos Rodriguez-Galindo; Jennifer W Mack; Asya Agulnik Journal: JCO Glob Oncol Date: 2020-07
Authors: Marcela Garza; Dylan E Graetz; Erica C Kaye; Gia Ferrara; Mario Rodriguez; Dora Judith Soberanis Vásquez; Alejandra Méndez Aceituno; Federico Antillon-Klussmann; Jami S Gattuso; Belinda N Mandrell; Justin N Baker; Carlos Rodriguez-Galindo; Asya Agulnik Journal: Front Oncol Date: 2021-06-23 Impact factor: 6.244