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Early Recognition of Critical Illness

  • Asya AgulnikEmail author
Chapter

Abstract

Hospitalized pediatric oncology and hematopoietic stem cell transplant patients are a high-risk population with frequent deterioration events requiring critical care. Early identification of critical illness in these patients can improve hospital outcomes and reduce mortality. Pediatric early warning systems (PEWS) and rapid response teams (RRTs) are quality improvement measures that aid in early recognition and management of critical illness in these high-risk patients.

Keywords

Cardiopulmonary arrest Critical deterioration Rapid response team (RRT) Medical emergency team (MET) Pediatric early warning system (PEWS) Resource-limited Global health 

References

  1. 1.
    Berg RA, Nadkarni VM, Clark AE, et al. Incidence and outcomes of cardiopulmonary resuscitation in PICUs. Crit Care Med. 2016;44(4):798–808.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Knudson JD, Neish SR, Cabrera AG, et al. Prevalence and outcomes of pediatric in-hospital cardiopulmonary resuscitation in the United States: an analysis of the Kids’ inpatient database*. Crit Care Med. 2012;40(11):2940–4.CrossRefGoogle Scholar
  3. 3.
    Del Castillo J, Lopez-Herce J, Canadas S, et al. Cardiac arrest and resuscitation in the pediatric intensive care unit: a prospective multicenter multinational study. Resuscitation. 2014;85(10):1380–6.CrossRefGoogle Scholar
  4. 4.
    Girotra S, Spertus JA, Li Y, et al. Survival trends in pediatric in-hospital cardiac arrests: an analysis from get with the guidelines-resuscitation. Circ Cardiovasc Qual Outcomes. 2013;6(1):42–9.CrossRefGoogle Scholar
  5. 5.
    Nadkarni VM, Larkin GL, Peberdy MA, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA. 2006;295(1):50–7.CrossRefGoogle Scholar
  6. 6.
    Demaret P, Pettersen G, Hubert P, Teira P, Emeriaud G. The critically-ill pediatric hemato-oncology patient: epidemiology, management, and strategy of transfer to the pediatric intensive care unit. Ann Intensive Care. 2012;2(1):14.CrossRefGoogle Scholar
  7. 7.
    Weiss SL, Fitzgerald JC, Pappachan J, et al. Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study. Am J Respir Crit Care Med. 2015;191(10):1147–57.CrossRefGoogle Scholar
  8. 8.
    Lindell RB, Gertz SJ, Rowan CM, et al. High levels of morbidity and mortality among pediatric hematopoietic cell transplant recipients with severe Sepsis: insights from the Sepsis PRevalence, OUtcomes, and therapies international point prevalence study. Pediatr Crit Care Med. 2017;18(12):1114–25.CrossRefGoogle Scholar
  9. 9.
    Tume L. The deterioration of children in ward areas in a specialist children’s hospital. Nurs Crit Care. 2007;12(1):12–9.CrossRefGoogle Scholar
  10. 10.
    Humphreys S, Totapally BR. Rapid response team calls and unplanned transfers to the pediatric intensive care unit in a pediatric hospital. Am J Crit Care. 2016;25(1):e9–13.CrossRefGoogle Scholar
  11. 11.
    Bonafide CP, Roberts KE, Priestley MA, et al. Development of a pragmatic measure for evaluating and optimizing rapid response systems. Pediatrics. 2012;129(4):e874–81.CrossRefGoogle Scholar
  12. 12.
    Cardoso LT, Grion CM, Matsuo T, et al. Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study. Crit Care. 2011;15(1):R28.CrossRefGoogle Scholar
  13. 13.
    Young MP, Gooder VJ, McBride K, James B, Fisher ES. Inpatient transfers to the intensive care unit: delays are associated with increased mortality and morbidity. J Gen Intern Med. 2003;18(2):77–83.CrossRefGoogle Scholar
  14. 14.
    Sankey CB, McAvay G, Siner JM, Barsky CL, Chaudhry SI. “Deterioration to door time”: an exploratory analysis of delays in escalation of care for hospitalized patients. J Gen Intern Med. 2016;31(8):895–900.CrossRefGoogle Scholar
  15. 15.
    Churpek MM, Wendlandt B, Zadravecz FJ, Adhikari R, Winslow C, Edelson DP. Association between intensive care unit transfer delay and hospital mortality: a multicenter investigation. J Hosp Med. 2016;11(11):757–62.CrossRefGoogle Scholar
  16. 16.
    Fausser JL, Tavenard A, Rialland F, et al. Should we pay attention to the delay before admission to a pediatric intensive care unit for children with Cancer? Impact on 1-month mortality. A report from the French children’s oncology study group, GOCE. J Pediatr Hematol Oncol. 2017;39(5):e244–8.CrossRefGoogle Scholar
  17. 17.
    100K Lives campaign—getting started kit: rapid response teams. http://www.ihi.org/IHI/Programs/Campaign/Campaign.htm. Accessed 7 Feb 2018.
  18. 18.
    Solomon RS, Corwin GS, Barclay DC, Quddusi SF, Dannenberg MD. Effectiveness of rapid response teams on rates of in-hospital cardiopulmonary arrest and mortality: a systematic review and meta-analysis. J Hosp Med. 2016;11(6):438–45.CrossRefGoogle Scholar
  19. 19.
    Brilli RJ, Gibson R, Luria JW, et al. Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit. Pediatr Crit Care Med. 2007;8(3):236–46. quiz 247CrossRefGoogle Scholar
  20. 20.
    Bonafide CP, Localio AR, Roberts KE, Nadkarni VM, Weirich CM, Keren R. Impact of rapid response system implementation on critical deterioration events in children. JAMA Pediatr. 2013;168(1):25–33.CrossRefGoogle Scholar
  21. 21.
    McNeill G, Bryden D. Do either early warning systems or emergency response teams improve hospital patient survival? A systematic review. Resuscitation. 2013;84(12):1652–67.CrossRefGoogle Scholar
  22. 22.
    Austin CA, Hanzaker C, Stafford R, et al. Utilization of rapid response resources and outcomes in a comprehensive cancer center*. Crit Care Med. 2014;42(4):905–9.CrossRefGoogle Scholar
  23. 23.
    Hayani O, Al-Beihany A, Zarychanski R, et al. Impact of critical care outreach on hematopoietic stem cell transplant recipients: a cohort study. Bone Marrow Transplant. 2011;46(8):1138–44.CrossRefGoogle Scholar
  24. 24.
    Chapman SM, Wray J, Oulton K, Peters MJ. Systematic review of paediatric track and trigger systems for hospitalised children. Resuscitation. 2016;109:87–109.CrossRefGoogle Scholar
  25. 25.
    McLellan MC, Gauvreau K, Connor JA. Validation of the children’s hospital early warning system for critical deterioration recognition. J Pediatr Nurs. 2017;32:52–8.CrossRefGoogle Scholar
  26. 26.
    Olson D, Preidis GA, Milazi R, et al. Task shifting an inpatient triage, assessment and treatment programme improves the quality of care for hospitalised Malawian children. Tropical Med Int Health. 2013;18(7):879–86.CrossRefGoogle Scholar
  27. 27.
    Sefton G, McGrath C, Tume L, Lane S, Lisboa PJ, Carrol ED. What impact did a paediatric early warning system have on emergency admissions to the paediatric intensive care unit? An observational cohort study. Intensive Crit Care Nurs. 2015;31(2):91–9.CrossRefGoogle Scholar
  28. 28.
    Parshuram CS, Dryden-Palmer K, Farrell C, et al. Effect of a pediatric early warning system on all-cause mortality in hospitalized pediatric patients: the EPOCH randomized clinical trial. JAMA. 2018;319(10):1002–12.CrossRefGoogle Scholar
  29. 29.
    Bonafide CP, Roberts KE, Weirich CM, et al. Beyond statistical prediction: qualitative evaluation of the mechanisms by which pediatric early warning scores impact patient safety. J Hosp Med. 2013;8(5):248–53.CrossRefGoogle Scholar
  30. 30.
    Bonafide CP, Localio AR, Song L, et al. Cost-benefit analysis of a medical emergency team in a children’s hospital. Pediatrics. 2014;134(2):235–41.CrossRefGoogle Scholar
  31. 31.
    Agulnik A, Antillon-Klussmann F, Soberanis Vasquez DJ, et al. Cost effectiveness of implementing a pediatric early warning system (PEWS) at a pediatric oncology hospital in a low-middle income country. Pediatr Blood Cancer. 2017;64(Suppl 3):S39.Google Scholar
  32. 32.
    Chapman SM, Wray J, Oulton K, Pagel C, Ray S, Peters MJ. ‘The score matters’: wide variations in predictive performance of 18 paediatric track and trigger systems. Arch Dis Child. 2017;102(6):487–95.CrossRefGoogle Scholar
  33. 33.
    Lambert V, Matthews A, MacDonell R, Fitzsimons J. Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review. BMJ Open. 2017;7(3):e014497.CrossRefGoogle Scholar
  34. 34.
    Parshuram CS, Duncan HP, Joffe AR, et al. Multicentre validation of the bedside paediatric early warning system score: a severity of illness score to detect evolving critical illness in hospitalised children. Crit Care. 2011;15(4):R184.CrossRefGoogle Scholar
  35. 35.
    Dean NP, Fenix JB, Spaeder M, Levin A. Evaluation of a pediatric early warning score across different subspecialty patients. Pediatr Crit Care Med. 2017;18(7):655–60.CrossRefGoogle Scholar
  36. 36.
    Olsen M, Mooney K, Evans E. Implementation of an early warning scoring system to identify patients with cancer at risk for deterioration. Clin J Oncol Nurs. 2016;20(4):374–6.CrossRefGoogle Scholar
  37. 37.
    Bokhari SW, Munir T, Memon S, Byrne JL, Russell NH, Beed M. Impact of critical care reconfiguration and track-and-trigger outreach team intervention on outcomes of haematology patients requiring intensive care admission. Ann Hematol. 2010;89(5):505–12.CrossRefGoogle Scholar
  38. 38.
    Young RS, Gobel BH, Schumacher M, Lee J, Weaver C, Weitzman S. Use of the modified early warning score and serum lactate to prevent cardiopulmonary arrest in hematology-oncology patients: a quality improvement study. Am J Med Qual. 2014;29(6):530–7.CrossRefGoogle Scholar
  39. 39.
    Demmel KM, Williams L, Flesch L. Implementation of the pediatric early warning scoring system on a pediatric hematology/oncology unit. J Pediatr Oncol Nurs. 2010;27(4):229–40.CrossRefGoogle Scholar
  40. 40.
    Agulnik A, Forbes PW, Stenquist N, Rodriguez-Galindo C, Kleinman M. Validation of a pediatric early warning score in hospitalized pediatric oncology and hematopoietic stem cell transplant patients. Pediatr Crit Care Med. 2016;17(4):e146–53.CrossRefGoogle Scholar
  41. 41.
    Agulnik A, Johnson S, Wilkes R, Faughnan L, Carrillo A, Morrison R. Impact of implementing a pediatric early warning system (PEWS) in a pediatric oncology hospital. Crit Care Med. 2018;46(1:Supplement):631.Google Scholar
  42. 42.
    Rodriguez-Galindo C, Friedrich P, Alcasabas P, et al. Toward the cure of all children with cancer through collaborative efforts: pediatric oncology as a global challenge. J Clin Oncol. 2015;33:3065–73.CrossRefGoogle Scholar
  43. 43.
    Ocen D, Kalungi S, Ejoku J, et al. Prevalence, outcomes and factors associated with adult in hospital cardiac arrests in a low-income country tertiary hospital: a prospective observational study. BMC Emerg Med. 2015;15:23.CrossRefGoogle Scholar
  44. 44.
    Lopez-Herce J, Del Castillo J, Matamoros M, et al. Factors associated with mortality in pediatric in-hospital cardiac arrest: a prospective multicenter multinational observational study. Intensive Care Med. 2013;39(2):309–18.CrossRefGoogle Scholar
  45. 45.
    Olotu A, Ndiritu M, Ismael M, et al. Characteristics and outcome of cardiopulmonary resuscitation in hospitalised African children. Resuscitation. 2009;80(1):69–72.CrossRefGoogle Scholar
  46. 46.
    Olson D, Davis NL, Milazi R, et al. Development of a severity of illness scoring system (inpatient triage, assessment and treatment) for resource-constrained hospitals in developing countries. Tropical Med Int Health. 2013;18(7):871–8.CrossRefGoogle Scholar
  47. 47.
    Agulnik A, Mora Robles LN, Forbes PW, et al. Improved outcomes after successful implementation of a pediatric early warning system (PEWS) in a resource-limited pediatric oncology hospital. Cancer. 2017;123(15):2965–74.CrossRefGoogle Scholar
  48. 48.
    Agulnik A, Mendez Aceituno A, Mora Robles LN, et al. Validation of a pediatric early warning system for hospitalized pediatric oncology patients in a resource-limited setting. Cancer. 2017;123(24):4903–13.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing 2019

Authors and Affiliations

  1. 1.Department of Global Pediatric Medicine, Division of Critical CareSt. Jude Children’s Research HospitalMemphisUSA

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