ICU Admission in Children With Acute Lymphoblastic Leukemia in Sweden: Prevalence, Outcome, and Risk Factors

Ranta, Susanna; Broman, Lars; Abrahamsson, Jonas; Berner, Jonas; Fläring, Urban; Myrberg, Ida Hed; Kalzén, Håkan; Karlsson, Lene; Mellgren, Karin; Nilsson, Anna; Norén‐Nyström, Ulrika; Palle, Josefine; Schewelov, Katarina von; Svahn, Johan; Törnudd, Lisa; Heyman, Mats; Harila‐Saari, Arja

doi:10.1097/pcc.0000000000002787

Cited by 6 publications

(4 citation statements)

References 28 publications

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“…Admissions not identified by chart review and lacking questionnaire data were shorter, occurred later after the AML diagnosis and were more often attributed to observational character than those with questionnaire data, suggesting missing notes in patient charts for short observations, possibly partly due to separate journal system used by ICUs or intensive care outside university hospitals. Our study in children with acute lymphoblastic leukaemia (ALL) showed a similar discrepancy in registration 12 . This finding of discrepancy highlights the importance of data source in studies on ICU care.…”

Section: Discussionsupporting

confidence: 52%

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

et al. 2022

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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.

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Section: Discussionsupporting

confidence: 52%

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

et al. 2022

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“…Some data that may be important for prognosis were not collected, including inotrope requirements, specific organ scores within PELOD, diagnosis of sepsis, neutropenia, timing during cancer therapy, disease status and stage, contents of and response to chemotherapy, hematopoietic stem cell transplantation, and type of leukemia or lymphoma. 1,17,18 Some of the variables collected occurred only rarely, for example, neurological diagnosis (2.8%), recovery from a surgical procedure (6.4%), ECMO (0.9%), HFOV (3.7%), iNO (7.3%), and RISC over 4 (3%), preventing their inclusion in the multiple regression models (we included only variables occurring in at least 5% of survivors and nonsurvivors). The lower mortality in our cohort than in previous cohorts may be due to general improvements in oncology and ICU care over time; however, we cannot be more specific given the limitations in our data set.…”

Section: Discussionmentioning

confidence: 99%

Mortality in Patients with Leukemia and Lymphoma Urgently Admitted to the PICU: Secondary Analysis of Data from a Cluster Randomized Controlled Trial

Nostedt,

Sinha,

Joffe

et al. 2024

J Pediatr Intensive Care

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Objectives were to describe the severity of illness in patients with leukemia or lymphoma urgently admitted to pediatric intensive care and explores the risk factors for mortality. A secondary analysis was performed of prospectively collected data from a cluster-randomized controlled trial in 21 children's hospitals from 2011 to 2015. Eligible patients were urgently admitted to intensive care and had a diagnosis of leukemia or lymphoma. Associations with intensive care mortality (primary outcome) were determined with multivariable generalized estimating equation with a logit link, accounting for clustering by site. Associations with time to intensive care mortality (secondary outcome) were determined with multivariable proportional hazards models. A total of 109 patients were included, age 115 (interquartile range [IQR] 42, 168) months and intensive care length of stay was 3 (IQR 2, 6) days. During the first hour in intensive care 36 (33%) were ventilated, and during intensive care 45 (41.3%) had at least 1 technology day. Day 1 Pediatric Logistic Organ Dysfunction (PELOD) score was ≥ 20 in 37 (33.9%), Pediatric Index of Mortality 2 mortality risk was > 10% in 35 (32.1%), and Children's Resuscitation Intensity Scale (RISC) was ≥ 3 (late admission to intensive care) in 32 (31.7%). Intensive care mortality was 20/109 (18.3%); with intensive care stay ≥ 20 days mortality was 51%. Previous urgent pediatric intensive care unit (PICU) admission, mechanical ventilation, and day 1 PELOD score were associated with higher PICU mortality. Mechanical ventilation, day 1 PELOD score, and late admission to the PICU (RISC ≥ 2) were associated with time to death. Patients with leukemia and lymphoma urgently admitted to intensive care had mortality of 18.3%, an improvement from historical cohorts. Risk factors were not accurate enough to make individual patient care decisions.

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“…These treatment protocols are however, associated with severe side effects. Infections and treatment-related toxicity conditions are leading causes for of mortality and morbidity in cancer patients that require treatment in the intensive care unit and 2% to 28% of the pediatric cancer patients have been shown to require admission to the PICU during their disease course (2)(3)(4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Organizational characteristics of European pediatric onco-critical care: An international cross-sectional survey

et al. 2022

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BackgroundIntensified treatment protocols have improved survival of pediatric oncology patients. However, these treatment protocols are associated with increased treatment-related morbidity requiring admission to pediatric intensive care unit (PICU). We aimed to describe the organizational characteristics and processes of care for this patient group across PICUs in Europe.MethodsA web-based survey was sent to PICU directors or representative physicians between February and June 2021.ResultsResponses were obtained from 77 PICUs of 12 European countries. Organizational characteristics were similar across the different countries of Europe. The median number of PICU beds was 12 (IQR 8–16). The majority of the PICUs was staffed by pediatric intensivists and had a 24/7 intensivist coverage. Most PICUs had a nurse-to-patient ratio of 1:1 or 1:2. The median numbers of yearly planned and unplanned PICU admissions of pediatric cancer patients were 20 (IQR 10–45) and 10 (IQR 10–30, respectively. Oncology specific practices within PICU were less common in participating centres. This included implementation of oncology protocols in PICU (30%), daily rounds of PICU physicians on the wards (13%), joint mortality and morbidity meetings or complex patients’ discussions (30% and 40%, respectively) and participation of parents during clinical rounds (40%).ConclusionOur survey provides an overview on the delivery of critical care for oncology patients in PICU across European countries. Multidisciplinary care for these vulnerable and challenging patients remains complex and challenging. Future studies need to determine the effects of differences in PICU organization and processes of care on patients’ outcome.

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ICU Admission in Children With Acute Lymphoblastic Leukemia in Sweden: Prevalence, Outcome, and Risk Factors

Cited by 6 publications

References 28 publications

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

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

Mortality in Patients with Leukemia and Lymphoma Urgently Admitted to the PICU: Secondary Analysis of Data from a Cluster Randomized Controlled Trial

Organizational characteristics of European pediatric onco-critical care: An international cross-sectional survey

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