Predicting Clinical Deterioration in Pediatric Hematology-Oncology Patients: PEWS Scales—A Scoping Review

Abstract

Introduction

Pediatric 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.

Method

A 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.

Results

Out 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.

Conclusion

While 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.