Pediatric early warning systems for children

Pediatric early warning systems (PEWS) – bedside tools used by nurses to assess the health of hospitalized children and identify urgent medical issues – are not widely used in resource-limited hospitals, in part due to the implementation difficulties. A recent article published by Wiley online in CANCERa peer-reviewed journal from the American Cancer Society, reports on a successful collaboration to support the implementation of a PEWS for children with cancer in Latin American hospitals.

In 2017, St. Jude Children’s Research Hospital partnered with pediatric oncology centers in Latin America to launch the Proyecto Escala de Valoración de Alerta Temprana (EVAT). St. Jude’s Asya Agulnik, MD, MPH, and colleagues reported that between April 2017 and October 2021, 36 diverse hospitals from 13 Latin American countries collectively managing more than 4,100 annual new pediatric cancer diagnoses implemented successfully the PEWS via Proyecto EVAT.

Centers took an average of seven months to complete implementation, and all, despite challenges related to geography, language, and the COVID-19 pandemic, maintained high-quality PEWS usage through 18 months after implementation. Across the 36 centers, more than 11,100 clinicians have been trained in PEWS and more than 41,000 hospitalized children have used PEWS in their care.

“This is the first multicenter, multinational study reporting a successful implementation strategy for scaling up PEWS regionally,” said Dr. Agulnik. “The strategy used by Proyecto EVAT to expand PEWS regionally in these 36 resource-limited centers can be generalized to facilitate the implementation of other interventions that improve patient outcomes in centers at all resource levels. We hope that the lessons learned from this work can broadly inform future programs to promote the adoption of interventions to improve cancer outcomes globally.

It should be noted that a comment published earlier this month in CANCER summarizes the major advances in pediatric cancer over the past 12 months. These advances in pediatric cancer focus on solid tumors, brain tumors, leukemia, recurrent disease and residual disease.

Further information

REMARK: The information contained in this press release is protected by copyright. Please include newspaper attribution in all covers. A free summary of this article will be available via the Cancer Newsroom as soon as it is published online. For more information or to obtain a PDF of a study, please contact: Sara Henning-Stout,

Full quotes:

“Regional Collaboration Model: Successful Strategy to Implement a Pediatric Early Warning System in 36 Pediatric Oncology Centers in Latin America.” Asya Agulnik, Alejandra Gonzalez Ruiz, Hilmarie Muniz-Talavera, Angela K. Carrillo, Adolfo Cárdenas, Maria F. Puerto-Torres, Marcela Garza, Tania Conde, Dora Judith Soberanis Vasquez, Alejandra Méndez Aceituno, Carlos Acuña Aguirre, Yvania Alfonso, Shillel Yahamy Álvarez Arellano, Deiby Argüello Vargas, Rosario Batista, Erika Esther Blasco Arriaga, Mayra Chávez Rios, María Elena Cuencio Rodríguez, Ever Amilcar Fing Soto, Wendy Gómez-García, Rafael H. Guillén Villatoro, María de Lourdes Gutiérrez Rivera, Martha Herrera Almanza , Yajaira V. Jimenez Antolinez, Maria Susana Juárez Tobias, Norma Araceli López Facundo, Ruth Angélica Martínez Soria, Kenia Miller, Scheybi Miralda, Roxana Morales, Natalia Negroe Ocampo, Alejandra Osuna, Claudia Pascual Morales, Clara Krystal Pérez Fermin, Carlos M. Pérez Alvarado, Estuardo Pineda, Carlos Andrés Portilla, Ligia Estefanía Rios López, Jocelyn Rivera, Arely Saraí Sagaón Olivares, Mélida Cristina Saguay Tacuri, Beatriz T. Salas Mendoza, Ivel Solano P icado, Verónica Soto Chávez, Isidoro Tejocote Romero, Daniel Tatay, Juliana Teixeira Costa, Erika Villanueva, Marielba Villegas Pacheco, Virginia R. McKay, Monika L. Metzger, Paola Friedrich and Carlos Rodriguez-Galindo, on behalf of the Study Group EVAT. CANCER; Published online: September 26, 2022 (DOI: 10.1002/cncr.34427).

URL when publishing:

“Main advances of the year: pediatric oncology.” Alberto S. Pappo, Seth E. Karol, and Kelsey C. Bertrand. CANCER; Published online: September 8, 2022 (DOI: 10.1002/cncr.34425).


Author contact details: or

About the journal
CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncology specialties. The goal of CANCER is to provide an interdisciplinary forum for the exchange of information between oncology disciplines concerned with the etiology, course and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and is available online.

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