Predicting Clinical Deterioration in Pediatric Hematology-Oncology Patients: PEWS Scales—A Scoping Review.

This article focuses on evaluating the predictive accuracy of Pediatric Early Warning Scores (PEWS) in identifying early clinical deterioration and predicting unplanned pediatric intensive care unit (PICU) transfers among pediatric hemato-oncological patients. A scoping review of seven studies published between 2013 and 2023 assessed four PEWS models—Bedside PEWS, Modified Bedside PEWS, Children's Hospital Early Warning Score (CHEWS), and Modified Brighton PEWS—demonstrating high predictive accuracy with area under the receiver operating characteristic curve (AUC) values ranging from 0.83 to 0.96. Increased PEWS scores within 24 hours of critical events were consistently associated with the need for urgent PICU transfer, and implementation of PEWS was linked to improved early detection, timely interventions, and reduced mortality in some settings. The review highlights the need for further large-scale, prospective, and multicenter research to validate and refine PEWS tools tailored to the heterogeneity of pediatric oncology patients and evolving therapies such as hematopoietic stem cell transplantation and CAR-T cell therapy.