Agulnik Asya, Forbes Peter W, Stenquist Nicole, Rodriguez-Galindo Carlos, Kleinman Monica
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.
Pediatr Crit Care Med. 2016 Apr;17(4):e146-53. doi: 10.1097/PCC.0000000000000662.
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.
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.
A large tertiary/quaternary free-standing academic children's hospital.
One hundred ten hospitalized pediatric oncology patients (42 oncology, 68 hematopoietic stem cell transplant) requiring unplanned PICU transfer and 220 matched controls.
None.
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).
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.
评估儿科早期预警评分与住院肿瘤及造血干细胞移植患儿计划外转入儿科重症监护病房（PICU）之间的相关性。
我们进行了一项回顾性匹配病例对照研究，比较了2011年9月至2013年12月期间住院的儿科肿瘤及造血干细胞移植患儿计划外转入PICU前24小时内记录的最高儿科早期预警评分。对照组为留在住院病房的患儿，按照年龄、病情（肿瘤与造血干细胞移植）和住院时间以2:1的比例进行匹配。作为常规护理的一部分，护理人员至少每4小时记录一次儿科早期预警评分。是否需要转入由被叫来评估患儿的PICU医生决定。
一家大型三级/四级独立的学术儿童医院。
110名需要计划外转入PICU的住院儿科肿瘤患者（42名肿瘤患者，68名造血干细胞移植患者）以及220名匹配的对照组患者。
无。
使用病例组转入前24小时内的最高评分以及对照组匹配时间段内的评分，儿科早期预警评分与总体转入PICU的需求高度相关（受试者工作特征曲线下面积=0.96），在肿瘤组和造血干细胞移植组中分别也是如此（受试者工作特征曲线下面积分别为0.95和0.96）。病例组和对照组之间的儿科早期预警评分结果差异早在转入PICU前24小时就已显现。17名患者死亡（15.4%）。转入前儿科早期预警评分较高的患者PICU死亡率（p=0.028）和住院时间（p=0.004）增加。
我们证明，我院的儿科早期预警评分与住院肿瘤及造血干细胞移植患儿计划外转入PICU的需求高度相关。此外，我们发现较高的评分与PICU死亡率之间存在关联。这是首次对特定于儿科肿瘤及造血干细胞移植人群的儿科早期预警评分进行验证，并支持将儿科早期预警评分作为早期识别该高危人群临床病情恶化的一种方法。
