Keywords
Clinical Deterioration
Escalation of Care
Pediatric Intensive Care Unit
Nursing
How to Cite
Abstract
Introduction. The management of critically ill pediatric oncohematology patients represents a major organizational and clinical challenge due to the high risk of rapid clinical deterioration related to both disease and treatment. Early recognition of deterioration and timely transfer to intensive care units (ICUs) are essential to improve outcomes. However, organizational models and emergency management pathways may vary significantly among centers. The aim of this study is to describe organizational models for the management and transfer of critically ill pediatric oncohematology patients across Italian centers, with particular focus on access to pediatric intensive care, escalation of care processes, use of clinical deterioration scores, multidisciplinary collaboration, and transfer procedures.
Methods. A multicenter cross-sectional descriptive survey was conducted among the 47 pediatric oncohematology centers belonging to the Italian Association of Pediatric Hematology and Oncology network. Data were collected between May and September 2024 through an ad hoc questionnaire developed by the Nursing Working Group after literature review and expert content validation. The questionnaire explored intensive care availability, transfer logistics, emergency response organization, clinical deterioration assessment systems, transfer documentation, and communication practices.
Results. Thirty-one centers participated (response rate 66%). Most centers were exclusively pediatric (80.6%), while 61.3% had an on-site pediatric intensive care unit (PICU). Among centers without a PICU, patients were transferred either to adult ICUs within the same hospital or to external pediatric ICUs. Transport modalities included stretcher transfer (51.6%), ambulance (25.8%), and helicopter emergency services. Clinical deterioration scores were used in 52% of centers, with Pediatric Early Warning Score (PEWS) being the most frequently adopted tool (69%). Critically ill patients were mainly managed within pediatric oncohematology wards or dedicated high-dependency areas (65%). ICU transfer decisions were multidisciplinary in 71% of centers. Most centers (84%) did not have a dedicated Medical Emergency Team or Transfer Rapid Response Team. Standardized nursing handover tools were used in only 32% of centers. Dedicated ICU rooms for pediatric oncohematology patients were available in 52% of centers.
Discussion. Despite organizational heterogeneity among Italian pediatric oncohematology centers, timely access to intensive care and multidisciplinary management are generally ensured. However, variability persists regarding emergency response structures, use of clinical deterioration scores, and standardized handover procedures. Strengthening shared organizational models, promoting structured communication tools, and implementing multidisciplinary training programs may further improve the management and safety of critically ill pediatric oncohematology patients.
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Copyright (c) 2026 Debora Botta, Domenico Grasso, Nadia Nicolini, Marta Canesi, Andrea Zibaldo, Eleonora Antenucci, Teresa Lupo, Simone Macchi, Matteo Amicucci