High need for intensive care in paediatric acute myeloid leukaemia: A population‐based study

Abstract

Aim Risk of treatment‐related life‐threatening toxicity is high in childhood acute myeloid leukaemia (AML), and access to intensive care units (ICU) is crucial. We explored the ICU admission rate and outcome after intensive care in childhood AML in Sweden. Methods Patients diagnosed between 2008 and 2016 were identified from the Swedish Childhood Cancer Registry (SCCR), a national quality registry. Data from SCCR was cross‐referenced with clinical questionnaire data from paediatric oncology centers and the Swedish Intensive Care Registry (SIR), another national quality registry. Results According to combined data, 46% of the children (58/126) were admitted to ICU, 17% (21/126) within 1 month from diagnosis. Overall, ICU mortality per admission was 12% and 6% during first‐line treatment. There was a discrepancy between admission rate from the clinical questionnaires and SCCR (29%; 36/126 children) and SIR (44%; 55/126) All deaths during first‐line treatment occurred at or after ICU care. Conclusion Although admission rate under AML treatment was high, the treatment‐related mortality under first‐line treatment was low. No child died under first‐line treatment without admission to ICU, suggesting good availability. The discrepancy between the two registries, SCCR and SIR, highlights the need for future validation of registry data.

Critical Care Utilization in Children With Cancer: U.S. Pediatric Health Information System Database Cohort 2012–2021

“…Over the period 2012-2021 in 36 PHIS database hospitals, we found that the number of hospitalizations for oncology cases remained consistent year-on-year, which in 2021 was 26,560. Of these hospitalizations, we identified an increase in the proportion of those requiring admission to PICU, which in 2021 was 19.6% (5,202). The consistent number of oncology hospitalizations, in the setting of known 2020-2020 U.S. National Cancer Institute increase in age-adjusted incidence of childhood cancer (7) may reflect the increasing use of outpatient therapies, therefore leading to higher acuity hospitalized patients.…”

“…In Australia and New Zealand, a 2003–2018 cohort concluded that there was an increasing rate of pediatric oncology patients admitted to the PICU (overall ~6% of all admissions) but falling mortality (4). A Swedish registry study of a 2008–2016 cohort found that 46% of children with acute myeloid leukemia required intensive care (5). There is little contemporary information for the United States, but our single-center cohort of acute myeloid leukemia patients (2011–2019) showed significant requirement for PICU treatments, particularly for multiple organ dysfunction syndrome (6).…”