title: Validation of a Pediatric Early Warning Score in Hospitalized Pediatric Oncology and Hematopoietic Stem Cell Transplant Patients.
abstract: OBJECTIVE
  To evaluate the correlation of a Pediatric Early Warning Score with unplanned transfer to the PICU in hospitalized oncology and hematopoietic stem cell transplant patients.
  
  
  METHODS
  We performed a retrospective matched case-control study, comparing the highest documented Pediatric Early Warning Score within 24 hours prior to unplanned PICU transfers in hospitalized pediatric oncology and hematopoietic stem cell transplant patients between September 2011 and December 2013. Controls were patients who remained on the inpatient unit and were matched 2:1 using age, condition (oncology vs hematopoietic stem cell transplant), and length of hospital stay. Pediatric Early Warning Scores were documented by nursing staff at least every 4 hours as part of routine care. Need for transfer was determined by a PICU physician called to evaluate the patient.
  
  
  METHODS
  A large tertiary/quaternary free-standing academic children's hospital.
  
  
  METHODS
  One hundred ten hospitalized pediatric oncology patients (42 oncology, 68 hematopoietic stem cell transplant) requiring unplanned PICU transfer and 220 matched controls.
  
  
  METHODS
  None.
  
  
  RESULTS
  Using the highest score in the 24 hours prior to transfer for cases and a matched time period for controls, the Pediatric Early Warning Score was highly correlated with the need for PICU transfer overall (area under the receiver operating characteristic = 0.96), and in the oncology and hematopoietic stem cell transplant groups individually (area under the receiver operating characteristic = 0.95 and 0.96, respectively). The difference in Pediatric Early Warning Score results between the cases and controls was noted as early as 24 hours prior to PICU admission. Seventeen patients died (15.4%). Patients with higher Pediatric Early Warning Scores prior to transfer had increased PICU mortality (p = 0.028) and length of stay (p = 0.004).
  
  
  CONCLUSIONS
  We demonstrate that our institution's Pediatric Early Warning Score is highly correlated with the need for unplanned PICU transfer in hospitalized oncology and hematopoietic stem cell transplant patients. Furthermore, we found an association between higher scores and PICU mortality. This is the first validation of a Pediatric Early Warning Score specific to the pediatric oncology and hematopoietic stem cell transplant populations, and supports the use of Pediatric Early Warning Scores as a method of early identification of clinical deterioration in this high-risk population.
authors.affiliation: 1Division of Critical Care Medicine, Department of Anesthesia, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA. 2Clinical Research Program, Boston Children's Hospital, Boston, MA. 3Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA.
authors.forename: Asya
authors.initials: A
authors.lastname: Agulnik
authors.forename: Peter W
authors.initials: PW
authors.lastname: Forbes
authors.forename: Nicole
authors.initials: N
authors.lastname: Stenquist
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodriguez-Galindo
authors.forename: Monica
authors.initials: M
authors.lastname: Kleinman
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003661:Decision Support Techniques; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis* / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000401:mortality; D010360:Patient Transfer / Q000706:statistics & numerical data; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index