Effect of paediatric early warning systems (PEWS) implementation on clinical deterioration event mortality among children with cancer in resource-limited hospitals in Latin America: a prospective, multicentre cohort study.

Autor:	Agulnik A; St Jude Children's Research Hospital, Memphis, TN, USA. Electronic address: asya.agulnik@stjude.org., Muniz-Talavera H; St Jude Children's Research Hospital, Memphis, TN, USA., Pham LTD; St Jude Children's Research Hospital, Memphis, TN, USA., Chen Y; St Jude Children's Research Hospital, Memphis, TN, USA., Carrillo AK; St Jude Children's Research Hospital, Memphis, TN, USA., Cárdenas-Aguirre A; St Jude Children's Research Hospital, Memphis, TN, USA., Gonzalez Ruiz A; St Jude Children's Research Hospital, Memphis, TN, USA., Garza M; St Jude Children's Research Hospital, Memphis, TN, USA., Conde Morelos Zaragoza TM; Casa de la Amistad, México City, México., Soberanis Vasquez DJ; Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala., Méndez-Aceituno A; Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala., Acuña-Aguirre C; Hospital Dr. Luis Calvo Mackenna, Santiago, Chile., Alfonso-Carreras Y; Hospital Saint Damien, Port-Au-Prince, Haiti., Alvarez Arellano SY; Benemérito Hospital General con Especialidades 'Juan María de Salvatierra', La Paz, México., Andrade Sarmiento LA; Centro Médico Nacional Siglo XXI, México City, México., Batista R; Hospital Jose Domingo De Obaldia, Chiriquí, Panama., Blasco Arriaga EE; SOLCA Guayaquil, Guayaquil, Ecuador., Calderon P; Hospital Infantil de Nicaragua, Managua, Nicaragua., Chavez Rios M; Hospital del Niño Poblano, Puebla, México., Costa ME; Hospital del Niños de la Santísima Trinidad de Córdoba, Cordoba, Argentina., Díaz-Coronado R; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru., Fing Soto EA; Hospital General de Celaya, Celaya, Mexico., Gómez García WC; Hospital Infantil Dr. Robert Reid Cabral, Santo Domingo, Dominican Republic., Herrera Almanza M; Hospital Infantil de Especialidades de Chihuahua, Chihuahua, Mexico., Juarez Tobías MS; Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico., León López EM; Hospital Guillermo Almenara Irigoyen, Lima, Peru., López Facundo NA; Instituto de Seguridad Social del Estado de México y Municipios Hospital Materno Infantil, Toluca, Mexico., Martinez Soria RA; Hospital General de Tijuana, Tijuana, Mexico., Miller K; Hospital del Niño 'Jose Renan Esquivel', Panama, Panama., Miralda Méndez ST; Hospital Escuela, Tegucigalpa, Honduras., Mora Robles LN; Instituto del Cáncer SOLCA Cuenca, Cuenca, Ecuador., Negroe Ocampo NDC; Hospital General Agustin O'Horan, Mérida, Mexico., Noriega Acuña B; Hospital de Especialidades Pediátricas, Tuxtla Gutierrez, Mexico., Osuna Garcia A; Hospital Pediátrico de Sinaloa, Culiacán, Mexico., Pérez Alvarado CM; Centro Estatal de Cancerología Dr Miguel Dorantes Mesa, Xalapa, Mexico., Pérez Fermin CK; Hospital Infantil Regional Universitario Dr. Arturo Grullón, Santiago, Dominican Republic., Pineda Urquilla EE; Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador., Portilla Figueroa CA; Centro Médico Imbanaco, Cali, Colombia., Ríos Lopez LE; Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru., Rivera Mijares J; Hospital Infantil Teletón de Oncología, Querétaro, Mexico., Soto Chávez V; Hospital Civil de Guadalajara, Guadalajara, Mexico., Suarez Soto JI; Hospital del Niño. Sistema integral para el Desarrollo de la Familia (DIF), Pachuca, Mexico., Teixeira Costa J; Hospital Martagão Gesteira, Salvador, Bahía, Brazil., Tejocote Romero I; Institutio Materno Infantil del Estado de México-IMIEM, Toluca, Mexico., Villanueva Hoyos EE; Hospital Oncológico Solca Núcleo de Quito, Quito, Ecuador., Villegas Pacheco M; Centro Estatal de Oncología, Campeche, Mexico., Devidas M; St Jude Children's Research Hospital, Memphis, TN, USA., Rodriguez-Galindo C; St Jude Children's Research Hospital, Memphis, TN, USA.
Jazyk:	angličtina
Zdroj:	The Lancet. Oncology [Lancet Oncol] 2023 Sep; Vol. 24 (9), pp. 978-988. Date of Electronic Publication: 2023 Jul 08.
DOI:	10.1016/S1470-2045(23)00285-1
Abstrakt:	Background: Paediatric early warning systems (PEWS) aid in the early identification of clinical deterioration events in children admitted to hospital. We aimed to investigate the effect of PEWS implementation on mortality due to clinical deterioration in children with cancer in 32 resource-limited hospitals across Latin America. Methods: Proyecto Escala de Valoración de Alerta Temprana (Proyecto EVAT) is a quality improvement collaborative to implement PEWS in hospitals providing childhood cancer care. In this prospective, multicentre cohort study, centres joining Proyecto EVAT and completing PEWS implementation between April 1, 2017, and May 31, 2021, prospectively tracked clinical deterioration events and monthly inpatient-days in children admitted to hospital with cancer. De-identified registry data reported between April 17, 2017, and Nov 30, 2021, from all hospitals were included in analyses; children with limitations on escalation of care were excluded. The primary outcome was clinical deterioration event mortality. Incidence rate ratios (IRRs) were used to compare clinical deterioration event mortality before and after PEWS implementation; multivariable analyses assessed the correlation between clinical deterioration event mortality and centre characteristics. Findings: Between April 1, 2017, and May 31, 2021, 32 paediatric oncology centres from 11 countries in Latin America successfully implemented PEWS through Proyecto EVAT; these centres documented 2020 clinical deterioration events in 1651 patients over 556 400 inpatient-days. Overall clinical deterioration event mortality was 32·9% (664 of 2020 events). The median age of patients with clinical deterioration events was 8·5 years (IQR 3·9-13·2), and 1095 (54·2%) of 2020 clinical deterioration events were reported in male patients; data on race or ethnicity were not collected. Data were reported per centre for a median of 12 months (IQR 10-13) before PEWS implementation and 18 months (16-18) after PEWS implementation. The mortality rate due to a clinical deterioration event was 1·33 events per 1000 patient-days before PEWS implementation and 1·09 events per 1000 patient-days after PEWS implementation (IRR 0·82 [95% CI 0·69-0·97]; p=0·021). In the multivariable analysis of centre characteristics, higher clinical deterioration event mortality rates before PEWS implementation (IRR 1·32 [95% CI 1·22-1·43]; p<0·0001), being a teaching hospital (1·18 [1·09-1·27]; p<0·0001), not having a separate paediatric haematology-oncology unit (1·38 [1·21-1·57]; p<0·0001), and having fewer PEWS omissions (0·95 [0·92-0·99]; p=0·0091) were associated with a greater reduction in clinical deterioration event mortality after PEWS implementation; no association was found with country income level (IRR 0·86 [95% CI 0·68-1·09]; p=0·22) or clinical deterioration event rates before PEWS implementation (1·04 [0·97-1·12]; p=0·29). Interpretation: PEWS implementation was associated with reduced clinical deterioration event mortality in paediatric patients with cancer across 32 resource-limited hospitals in Latin America. These data support the use of PEWS as an effective evidence-based intervention to reduce disparities in global survival for children with cancer. Funding: American Lebanese Syrian Associated Charities, US National Institutes of Health, and Conquer Cancer Foundation. Translations: For the Spanish and Portuguese translations of the abstract see Supplementary Materials section. Competing Interests: Declaration of interests We declare no competing interests. (Copyright © 2023 Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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