Miralda MST

Language: Spanish
References: 15
Page: 209-217
PDF size: 232.94 Kb.

ABSTRACT

Background: Hospitalized pediatric cancer patients have a higher risk of developing acute complications that lead to clinical deterioration and transfer to the Pediatric Intensive Care Unit.
Objective: Characterize the pediatric cancer patient with clinical deterioration according to the Early Warning Assessment Scale in a tertiary hospital.
Materials and Methods: Analytical cross-sectional study that included 92 cancer patients treated in the Pediatric Hemato-Oncology room, Hospital Escuela, between January 2017 to December 2021, who presented clinical deterioration event during hospitalization. values of the Early Warning Assessment Scale for Honduras are described prior to the event and PIM2-100% as a predictor of discharge condition.
Results: Mean age 9.7 years (+/-4.9; range 10 months-17 years), male 52.2% (48/92) cases. The most frequent oncological diagnosis was Acute Lymphoblastic Leukemia 58.7% (54/92) cases. The main cause of clinical deterioration event was sepsis/septic shock (70.7%, 65/92) cases. Very severe thrombocytopenia (29.3%, 27/92) and elevated C-Reactive Protein (30.4%, 28/92) cases. The risk of deterioration according to the Early Warning Assessment Scale for Honduras prior to the event was moderate risk (40.2% 37/92); 70.7% (65/92) of cases were transferred to the Pediatric Intensive Care Units due to the need for hemodynamic support (52.3%, 34/65). 60.9% (56/92) presented organ dysfunction, 23.9% (22/92) cases died. A statistical association was found between 100% PIM2 and discharge condition (p=0.005; RR:2.74; 95% CI 1.24-6.02).
Conclusion: The casuistry of the hospitalized pediatric cancer patient who presented an event of clinical deterioration according to Early Warning Assessment Scale adapted for Honduras, it presents a high proportion of organic dysfunction, it is possible to obtain good results in settings with limited resources.

REFERENCES

1. Padilla RM, Mayo AM. Clinical deterioration: A conceptanalysis. J Clin Nurs. 2018;27(7-8):1360-8.

2. Roland D, Stilwell PA, Fortune PM, Alexander J, Clark SJ,Kenny S. Case for change: a standardised inpatient paediatricearly warning system in England. Arch Dis Child.2021;106(7):648-51.

3. Jensen CS, Kirkegaard H, Aagaard H, Olesen HV. Clinicalprofile of children experiencing in-hospital clinical deteriorationrequiring transfer to a higher level of care. J ChildHealth Care. 2018:1367493518794400.

4. Chapman SM, Wray J, Oulton K, Pagel C, Ray S, Peters MJ.'The Score Matters': wide variations in predictive performanceof 18 paediatric track and trigger systems. Arch DisChild. 2017;102(6):487-95.

5. Agulnik A, Gossett J, Carrillo AK, Kang G, Morrison RR.Abnormal Vital Signs Predict Critical Deterioration in HospitalizedPediatric Hematology-Oncology and Post-hematopoieticCell Transplant Patients. Front Oncol 2020;10:354.

6. Sambeeck SJV, Fuijkschot J, Kramer BW, Vos GD. PediatricEarly Warning System Scores: Lessons to be Learned. JPediatr Intensive Care. 2018;7(1):27-32.

7. Agulnik A, Nadkarni A, Mora Robles LN, Soberanis VasquezDJ, Mack R, Antillon-Klussmann F, et al. Pediatric Early WarningSystems aid in triage to intermediate versus intensivecare for pediatric oncology patients in resource-limitedhospitals. Pediatr Blood Cancer. 2018;65(8):e27076.

8. Chapman SM, Maconochie IK. Early warning scores in paediatrics:an overview. Arch Dis Child. 2019;104(4):395-9.

9. Soeteman M, Kappen TH, van Engelen M, Kilsdonk E,Koomen E, Nieuwenhuis EES, et al. Identifying the criticallyill paediatric oncology patient: a study protocol for aprospective observational cohort study for validation of amodified Bedside Paediatric Early Warning System scorein hospitalised paediatric oncology patients. BMJ Open.2021;11(5):e046360.

10. Agulnik A, Cardenas A, Carrillo AK, Bulsara P, Garza M,Alfonso Carreras Y, et al. Clinical and organizational riskfactors for mortality during deterioration events amongpediatric oncology patients in Latin America: A multicenterprospective cohort. Cancer. 2021;127(10):1668-78..

11. Miralda Méndez ST. Escala de valoración del deteriorodel paciente oncológico pediátrico hospitalizado, HospitalEscuela, Tegucigalpa, 2017-2019. Rev Med Hondur.2021;89(2):117-23.

12. Garza M, Graetz DE, Kaye EC, Ferrara G, Rodriguez M,Soberanis Vasquez DJ, et al. Impact of PEWS on PerceivedQuality of Care During Deterioration in Children WithCancer Hospitalized in Different Resource-Settings. FrontOncol. 2021;11:660051.

13. Dean NP, Fenix JB, Spaeder M, Levin A. Evaluation of aPediatric Early Warning Score Across Different SubspecialtyPatients. Pediatr Crit Care Med. 2017;18(7):655-60.

14. Stotts JR, Lyndon A, Chan GK, Bekmezian A, Rehm RS. NursingSurveillance for Deterioration in Pediatric Patients: AnIntegrative Review. J Pediatr Nurs. 2020;50:59-74.

15. Roa S. Implementación de una Escala de Valoración yAlerta Temprana en pacientes oncológicos pediátricos enun Hospital de la ciudad de Cartagena. Cartagena de Indias,Colombia: Universidad de Cartagena; 2020.