Indications for admission, treatment and improved outcome of paediatric haematology/oncology patients admitted to a tertiary paediatric ICU

Owens, Cormac; Mannion, D.; O’Marcaigh, Aengus; Waldron, Mary; Butler, Karina; O’Meara, Anne

doi:10.1007/s11845-010-0634-8

Cited by 25 publications

(34 citation statements)

References 19 publications

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“…First, the overall PICU mortality rate of 6.8% in our cohort is significantly lower than most reports from the last 20 years (13–27%) [2, 7–9, 13]. While encouraging, this finding should be interpreted with caution due to heterogeneity among published cohorts with regards to both patient and center characteristics, such as cancer types and PICU admission criteria.…”

Section: Discussioncontrasting

confidence: 53%

Pediatric cancer type predicts infection rate, need for critical care intervention, and mortality in the pediatric intensive care unit

et al. 2014

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PURPOSE Up to 38% of children with cancer require PICU admission within three years of diagnosis, with reported PICU mortality of 13–27% far exceeding that of the general PICU population. PICU outcomes data for individual cancer types are lacking and may help identify patients at risk for poor clinical outcomes. METHODS We performed a retrospective multi-center analysis of 10,365 PICU admissions of cancer patients ≤ 21 years old among 112 PICUs between 1/1/2009 and 6/30/2012. We evaluated the effect of cancer type, age, gender, genetic syndrome, stem cell transplantation, PRISM3 score, infections, and critical care interventions on PICU mortality. RESULTS After excluding scheduled perioperative admissions, cancer patients represented 4.2% of all PICU admissions (10,365/246,346), had overall mortality of 6.8% (708/10,365) vs. 2.4% (5,485/230,548) in the general PICU population (RR=2.9, 95% CI 2.7–3.1, p<0.001), and accounted for 11.4% of all PICU deaths (708/6,215). Hematologic cancer patients had greater median PRISM3 score (8 vs 2, p<0.001), rates of sepsis (27% vs 9%, RR=2.9, 95% CI 2.6–3.1, p<0.001), and mortality (9.6% vs 4.5%, RR=2.1, 95% CI 1.8–2.5, p<0.001) compared to solid cancer patients. Among hematologic cancer patients, stem cell transplantation, diagnosis of acute myeloid leukemia, PRISM3 score, and infection were all independently associated with PICU mortality. CONCLUSIONS Children with cancer account for 4.2% of PICU admissions and 11.4% of PICU deaths. Hematologic cancer patients have significantly higher admission illness severity, rates of infections, and PICU mortality than solid cancer patients. These data may be useful in risk-stratification for closer monitoring and patient counseling.

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Section: Discussioncontrasting

confidence: 53%

Pediatric cancer type predicts infection rate, need for critical care intervention, and mortality in the pediatric intensive care unit

et al. 2014

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“…6,11,13,14 These children often have severe myelo-and immunosuppression and are more likely than other paediatric patients to require PICU care. 1,14 Timely recognition and early PICU admission offer opportunities to prevent and manage life-threatening complications of cancer management. 15 In the study, oncology admissions comprised 2.1% of all PICU admissions.…”

Section: Discussionmentioning

confidence: 99%

“…1 Patients in upper middleincome countries may have inconsistent access to specialised services, and admission of paediatric oncology patients to paediatric intensive care units (PICUs) is not guaranteed. South Africa has a fragmented, two-tiered health care system based on both privately funded and state-run services.…”

Section: Introductionmentioning

confidence: 99%

Appropriateness of admissions of children with cancer to intensive care facilities in a resource-limited setting

et al. 2017

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Background: The increasing intensity of treatment of paediatric malignancies has led to improved survival rates, but often necessitates intensive supportive care. The decision to admit a child to the paediatric intensive care unit (PICU) is based on the probability of both short-term and long-term survival in the context of severe resource constraints. Resource constraints in South Africa result in limited access of children with cancer to PICU facilities. Objectives: The aim of this study was to determine whether referrals by paediatric oncologists to a PICU in Johannesburg were appropriate by analysing indications for admission, underlying diagnoses, duration and costs of admissions, and overall outcomes. Methods: A retrospective review of consecutive PICU admissions over a 12-year period was performed. Data from all patients with histologically proven malignant conditions were included and analysed using descriptive statistical methods, Kaplan–Meier curves, log-rank analysis and Fisher’s exact test. Results: There were 5704 recorded admissions to PICU in the study period. Of these admissions, 120 (2.1%) were for patients with malignancies. The majority of PICU oncology admissions were for post-operative care, and the median duration of stay was 1 day (interquartile range: 1–3 days). The short-term mortality rate of oncology patients in PICU was 13.3% in comparison with 16.2% in the overall PICU population. The 4-year overall survival rate post PICU discharge was 54%. Conclusion: The documented short-term mortality rate indicates that referrals by paediatric oncologists are consistent with current PICU admission policies. Oncologists should assess the prognosis for survival before requesting admission to PICU, and, resources permitting, these patients should be accepted to PICU.

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“…Similar a los resultados de otros autores, al evaluar la mortalidad se encontró en el presente estudio con mayor frecuencia la presencia de infección 6,7,10,21,29 , y el requerimiento de ventilación mecánica invasiva 6,7,10,29 , de terapias de reemplazo renal 10 y de algún vasoactivo 6,7,10,13,30,31 , lo que genera hipótesis de estudio para propuestas posteriores al respecto.…”

Section: Discussionunclassified

“…Con la mejoría en la caracterización bioló-gica de los diferentes tipos de cáncer, la optimización de técnicas diagnósticas, los ajustes en los sistemas de clasificación de la enfermedad, la aplicación de tratamientos adaptados a riesgos y los nuevos tratamientos de apoyo para reducir las muertes tóxicas, el pronóstico de los niños con cáncer ha mejorado logrando actualmente supervivencias a 5 años que varían entre el 70 y 80% 1,4---6 ; esto atribuido también a la mayor agresividad en la quimioterapia 7,8 , que a su vez condiciona un aumento sustancial en la morbilidad derivada de la inmunosupresión y mielosupresión 7,9 , además de la toxicidad renal y cardiaca de estos agentes 10 .…”

Section: Introductionunclassified

Caracterización de los pacientes de una Unidad de Cuidado Intensivo Pediátrico exclusivamente oncológica

Arias

Godoy

Maya

et al. 2015

Revista Colombiana de Cancerología

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Recibido el 7 de noviembre de 2014; aceptado el 24 de abril de 2015 Disponible en Internet el 18 de junio de 2015 PALABRAS CLAVENiño; Neoplasia; Cuidado intensivo; Mortalidad ResumenObjetivo: La ley colombiana en 2010 propone disminuir la mortalidad por cáncer en menores de 18 años. El Instituto Nacional de Cancerología en respuesta, crea la primera Unidad de Cuidado Intensivo Pediátrico para paciente oncológico en el país. El objetivo de este trabajo fue describir las características demográficas y patológicas de los pacientes atendidos en esta unidad desde octubre de 2011 hasta junio de 2013. Métodos: Se realizó un estudio observacional descriptivo prospectivo, que incluyó todos los pacientes menores de 18 años de edad, con sospecha o diagnóstico confirmado de cáncer. Se reportaron sus diagnósticos y características demográficas, y se describió la mortalidad encontrada. Resultados: Se describieron 261 ingresos con 201 pacientes, 53% de sexo femenino, con una mediana de edad de 7 años. La estancia hospitalaria promedio fue de 6 días. La frecuencia de la mortalidad fue 32 pacientes (15,9%), la mayoría de ellos por disfunción multiorgánica en relación con choque séptico. Se observó una frecuencia alta de ventilación mecánica invasiva, uso de vasoactivos, terapias de reemplazo renal y diagnóstico infeccioso en los pacientes que fallecieron. Conclusiones: Se concluyó que el comportamiento de los pacientes del estudio se asemeja a lo reportado en la literatura, excepto que en este caso las infecciones se presentaron con mayor frecuencia en los casos de mortalidad, por lo cual se hace importante explorar los condicionantes de esto en estudios futuros.

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Indications for admission, treatment and improved outcome of paediatric haematology/oncology patients admitted to a tertiary paediatric ICU

Abstract: While mortality rates for paediatric oncology patients admitted to a ICU have improved, they are still substantial. Those with a haematological malignancy or admitted with sepsis are most at risk.

Cited by 25 publications

References 19 publications

Pediatric cancer type predicts infection rate, need for critical care intervention, and mortality in the pediatric intensive care unit

Pediatric cancer type predicts infection rate, need for critical care intervention, and mortality in the pediatric intensive care unit

Appropriateness of admissions of children with cancer to intensive care facilities in a resource-limited setting

Caracterización de los pacientes de una Unidad de Cuidado Intensivo Pediátrico exclusivamente oncológica

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