Oncological pediatric early warning score: a dedicated tool to predict patient’s clinical deterioration and need for pediatric intensive care treatment

Abstract

Pediatric oncohematological patients frequently require PICU admission during their clinical history. The O-PEWS is a specific score developed to predict the need for PICU admission of oncohematological children. This study aimed at i) describing the trend of the O-PEWS in a cohort of patients hospitalized in the Pediatric Oncohematology ward and transferred to the PICU of Padua University Hospital, measured at different time-points in the 24 hours before PICU admission and to evaluate its association with mortality and presence of organ failure; ii) investigating the association between the recorded O-PEWS, and PIM3, number of organ failure and the need for ventilation, dialysis and inotropes.

This retrospective single-center study enrolled oncohematological children admitted to the PICU between 2017 and 2021. The O-PEWS, ranging between 0 and 15, was calculated on the available medical records and the TIPNet-Network database at 24 (T-24), 12 (T-12), 6 (T-6) and 0 (T0) hours before PICU admission.

RESULTS: 101 PICU admissions, related to 80 children, were registered. During the 24 hours prior to PICU admission, the O-PEWS progressively increased in all the patients. At T-24 the median O-PEWS was 3 (IQR 1-5), increasing to a median value of 6 (IQR 4-8) at T0. The O-PEWS was positively associated with mortality, organ failure and the need for ventilation at all the analyzed time-points and with the need for dialysis at T-6.

The O-PEWS appears as a useful tool for predicting early clinical deterioration in oncohematological patients and for anticipating the initiation of life-support treatments.

Keywords:

• Oncology
• outcome
• pediatric
• PICU
• warning score

Acknowledgements

The authors would like to thank the patients and their families, and the medical and nursing staff who took care of them. In addition, Authors would like to thank Fondazione Giacomo Ascoli, Varese, Italy, Associazione italiana contro le leucemie-linfomi e mieloma, Italy, and Comitato Assistenza Socio-Sanitaria in Oncoematologia Pediatrica, Padova, Italy, for their support.

Disclosure statement

All the authors declare no conflict of interest.

Data availability statement

The data that support the findings of this study are available from the corresponding author, AM, upon reasonable request.

Additional information

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript