P3.077: Associations between Pediatric Early Warning Systems (PEWS) Scores and outcomes of clinical deterioration events in hospitalized children with cancer in Latin America.

Background: Pediatric Early Warning Systems (PEWS) are quality improvement tools for early detection of hospitalized children at risk of clinical deterioration events (CDE). Proyecto Escala de Valoracion de Alerta Temprana (Proyecto EVAT) is a multicenter quality-improvement collaborative supporting PEWS implementation in hospitals providing childhood cancer care in Latin America and Spain. While PEWS implementation has been shown to reduce CDE mortality, the relationship between PEWS scores and outcomes of CDE is unknown. We aim to explore the relationship of overall PEWS scores and subscore components (neurological, respiratory, cardiovascular, nurse concern, and family concern) with CDE mortality and outcomes.

Methods: Centers participating in Proyecto EVAT that adhered to PEWS protocols before, during, and after implementation reported all clinical deterioration events (CDEs) among hospitalized children with cancer to a prospective quality improvement registry. CDE mortality was defined as death occurring during a deterioration event, either in the intensive care unit (ICU), within 24 hours after ICU discharge, or following the last intensive care intervention on the hospital ward. Registry data entered from April 2017 (start of Proyecto EVAT) through October 2021 were included. All events with a documented PEWS score within 24 hours before CDE onset were analyzed. Univariate logistic regression evaluated the association of PEWS subscores with CDE mortality and outcomes. Non-parametric linear regression assessed the relationship between PEWS scores and the duration of ICU-level interventions, including mechanical ventilation and vasoactive infusions.

Results: This study included 2257 CDEs with documented PEWS occurring among 1817 children diagnosed with cancer admitted to 47 centers across 16 countries in Latin America and Spain. Higher PEWS scores were significantly associated with increased CDE mortality, with each unit increase in PEWS score raising the odds of mortality during the CDE by 23% (OR = 1.23, 95% CI: 1.17-1.29, p< 0.001). Neurological, respiratory, and cardiovascular subscores were significant predictors of CDE mortality, with the most severe respiratory impairment (r=3) nearly tripling the odds of mortality (OR = 2.96, 95% CI: 2.20-4.02, p< 0.001). Additionally, family concern was significantly associated with increased mortality (OR = 1.70, 95% CI: 1.36-2.14, p< 0.001). Higher PEWS scores were associated with need for ICU-level interventions; mechanical ventilation (OR = 1.26, 95% CI: 1.21-1.32, p< 0.001), vasopressor use (OR = 1.08, 95% CI: 1.04-1.12, p< 0.001), and CPR (OR = 1.26, 95% CI: 1.19-1.35, p< 0.001). Furthermore, PEWS scores were positively correlated with the duration of mechanical ventilation (Estimate = 0.29, p< 0.001).

Conclusion: These findings suggest that PEWS scores within 24 hours before CDE are significant predictors of clinical deterioration outcomes like mortality and clinical interventions. This underscores PEWS as a crucial, practical intervention that can improve survival rates and reduce healthcare disparities globally, emphasizing its potential to save numerous lives if adopted widely.