Identifying the critically ill paediatric oncology patient: a study protocol for a prospective observational cohort study for validation of a modified Bedside Paediatric Early Warning System score in hospitalised paediatric oncology patients

Abstract

IntroductionHospitalised paediatric oncology patients are at risk to develop acute complications. Early identification of clinical deterioration enabling adequate escalation of care remains challenging. Various Paediatric Early Warning Systems (PEWSs) have been evaluated, also in paediatric oncology patients but mostly in retrospective or case–control study designs. This study protocol encompasses the first prospective cohort with the aim of evaluating the predictive performance of a modified Bedside PEWS score for non-elective paediatric intensive care unit (PICU) admission or cardiopulmonary resuscitation in hospitalised paediatric oncology patients.Methods and analysisA prospective cohort study will be conducted at the 80-bed Dutch paediatric oncology hospital, where all national paediatric oncology care has been centralised, directly connected to a shared 22-bed PICU. All patients between 1 February 2019 and 1 February 2021 admitted to the inpatient nursing wards, aged 0–18 years, with an International Classification of Diseases for Oncology (ICD-O) diagnosis of paediatric malignancy will be eligible. A Cox proportional hazard regression model will be used to estimate the association between the modified Bedside PEWS and time to non-elective PICU transfer or cardiopulmonary arrest. Predictive performance (discrimination and calibration) will be assessed internally using resampling validation. To account for multiple occurrences of the event of interest within each patient, the unit of study is a single uninterrupted ward admission (a clinical episode).Ethics and disseminationThe study protocol has been approved by the institutional ethical review board of our hospital (MEC protocol number 16-572/C). We adapted our enrolment procedure to General Data Protection Regulation compliance. Results will be disseminated at scientific conferences, regional educational sessions and publication in peer-reviewed journals.Trial registration numberNetherlands Trial Registry (NL8957).

Validation of a modified bedside Pediatric Early Warning System score for detection of clinical deterioration in hospitalized pediatric oncology patients: A prospective cohort study

“…A detailed description of the study rationale and design was previously described 17 . We performed a prospective cohort study between February 1, 2019 and February 1, 2021 at the Princess Máxima Center, an 80‐bed national referral center for pediatric oncology in the Netherlands.…”

“…A detailed description of the study rationale and design was previously described. 17 We performed a prospective cohort study between We evaluated the BedsidePEWS as used in our hospital. At implementation in our hospital in 2014, the score had been slightly modified by adding temperature and categorization of oxygen therapy (Table S1 and Figure S1).…”

Accuracy and effectiveness of electronic pediatric early warning score (PEWS): A literature review

“…Bedside PEWS atau CDR PEWS Tidak ada perbedaan yang signifikan dalam memprediksi pemindahan yang tidak direncanakan ke tingkat perawatan yang lebih tinggi (P = 0.78) terdeteksi dan (Soeteman, Kappen, van Engelen, Kilsdonk, Koomen, Nieuwenhuis, & Wösten-van Asperen, 2021).…”

International Experience in Applying the System of Pediatric Early Warning Signs of Critical Conditions in Oncological Children: A Literature Review

“…В голландской детской онкологической больнице, где централизована вся национальная детская онкологическая помощь и которая напрямую подключена к общему ОРИТ на 22 койки, было проведено проспективное когортное исследование, результаты которого могут предоставить дополнительные доказательства преимущества использования системы PEWS у госпитализированных пациентов с детской онкологией или указать на то, что PEWS нуждается в оптимизации (модификации) у детей с онкологическими заболеваниями [31].…”