Critically ill patients

Background

Hospitalized pediatric oncology patients are at risk for rapid clinical deterioration due to the aggressive cancer itself and toxicity of treatment. Timely recognition of deteriorating patients is essential to promptly start an intervention, aimed to halt progression to irreversible organ dysfunction and death. 

Aims

• One of the research aims of this project was to validate a modified bedside Pediatric Early Warning System (PEWS) score in an applied setting of hospitalized pediatric oncology patients. This study yielded valuable insights into the predictive performance of a PEWS score for detecting deteriorating patients. 

• A second study aimed to identify risk factors at the start of Pediatric Intensive Care Unit (PICU) admission for new or progressive multi-organ dysfunction. The independent risk factors, and frequently failing organ systems at PICU admission may help to identify patients who may benefit from closer monitoring and early interventions. 

Relevance for cancer research

This project forms an important step towards improving the timely identification of critically ill pediatric oncology patients, with the ultimate aim of improving patients' outcome.

Project Outcomes

• Soeteman M, Kappen TH, van Engelen M, Marcelis M, Kilsdonk E, van den Heuvel-Eibrink MM, Nieuwenhuis EES, Tissing WJE, Fiocco M & van Asperen RMW (2023). Validation of a modified bedside Pediatric Early Warning System score for detection of clinical deterioration in hospitalized pediatric oncology patients: A prospective cohort study. Pediatric Blood & Cancer, 70(1):e30036. doi: 10.1002/pbc.30036

• Soeteman M, Fiocco F, Nijman J, Bollen CW, Marcelis MM, Kilsdonk E, Nieuwenhuis EES, Kappen TH, Tissing WJE & Wösten-van Asperen RM (2023). Prognostic factors for multi-organ dysfunction in pediatric oncology patients admitted to the pediatric intensive care unit. Frontiers in Oncology, 13:1192806. doi: 10.3389/fonc.2023.1192806

• Soeteman M, Lekkerkerker CW, Kappen TH, Tissing WJ, Nieuwenhuis EE & Wösten-van Asperen RM (2022). The predictive performance and impact of pediatric early warning systems in hospitalized pediatric oncology patients-A systematic review. Pediatric Blood & Cancer, 69(5):e29636. doi: 10.1002/pbc.29636

• Soeteman M, Kappen TH, van Engelen M, Kilsdonk E, Koomen E, Nieuwenhuis EES, Tissing WJE, Fiocco M, van den Heuvel-Eibrink M & Wösten-van Asperen RM (2021). Identifying the critically ill paediatric oncology patient: a study protocol for a prospective observational cohort study for validation of a modified Bedside Paediatric Early Warning System score in hospitalised paediatric oncology patients. BMJ Open, 11(5):e046360. doi: 10.1136/bmjopen-2020-046360

• Soeteman M, Potratz J, Nielsen JSA, Willems J, Valla FV, Brierley J & Wösten-van Asperen RM; POKER (PICU Oncology Kids in Europe Research group) research consortium of ESPNIC (European Society of Paediatric Neonatal Intensive Care) (2019). Research priorities in pediatric onco-critical care: an international Delphi consensus study. Intensive Care Medicine, 45(11):1681-1683. doi: 10.1007/s00134-019-05706-x

Team

• Prof.dr. M. Fiocco, Mathematical Institute Leiden University, Department of Biomedical Data Sciences Leiden University Medical Center & Princess Máxima Center for Pediatric Oncology 

• Dr. T.H. Kappen, University Medical Center Utrecht 

• Prof.dr. E.E.S. Nieuwenhuis, University Medical Center Utrecht 

• Drs. M. Soeteman, Princess Máxima Center for Pediatric Oncology & Wilhelmina Children's Hospital

• Prof.dr. W.J.E. Tissing, Princess Máxima Center for Pediatric Oncology & University Medical Center  Groningen

• Dr. R.M. Wösten – van Asperen,  University Medical Center Utrecht & Wilhelmina Children's Hospital