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Improved outcomes of children with malignancy admitted to a pediatric intensive care unit
A R Hallahan1, P J Shaw, G Rowell
1Pediatric Intensive Care Unit, The Royal Alexandra Hospital for Children, The New Children's Hospital, Sydney, Australia.
Insights
Pediatric oncology patients admitted to the intensive care unit (ICU) for cancer or bone marrow transplant complications have improved survival rates. Many children requiring intensive interventions in the ICU survive and achieve cancer remission.
Area of Science:
- Pediatric critical care medicine
- Pediatric oncology
- Hematopoietic stem cell transplantation outcomes
Background:
- Children with cancer or post-bone marrow transplant complications admitted to the pediatric intensive care unit (PICU) face significant risks.
- Assessing outcomes is crucial for understanding treatment efficacy and improving care for this vulnerable population.
Purpose of the Study:
- To evaluate the acute and long-term outcomes for pediatric patients with malignancies or bone marrow transplant complications admitted to the PICU.
- To identify trends in survival and identify factors influencing outcomes in this patient group.
Main Methods:
- Retrospective analysis of a prospective PICU database.
- Inclusion of 150 pediatric patients with malignancies or bone marrow transplant complications admitted between 1987 and 1996.
- Review of case notes to supplement database information.
Main Results:
- 206 PICU admissions were analyzed, with a 27% overall mortality rate (40 deaths).
- Shock and respiratory disease were the most common reasons for PICU admission.
- Long-term survival estimates were 50% for all oncology patients and 42% for those admitted with shock.
Conclusions:
- A significant number of pediatric oncology patients admitted to the PICU for intensive interventions survive and achieve remission.
- The study indicates an improvement in PICU outcomes for pediatric oncology patients over the study period.
Objective:
To assess the acute and long-term outcomes of children admitted to the intensive care unit with cancer or complications after bone marrow transplantation.
Design:
Retrospective analysis of databases from a prospective pediatric intensive care unit (PICU) database supplemented by case notes review.
Setting:
A PICU in a tertiary pediatric hospital.
Patients:
All children with malignancy admitted to the PICU between May 1, 1987, and April 30, 1996.
Interventions:
None.
Measurements And Main Results:
There were 206 admissions to the PICU during a 9-yr study period of 150 children with malignancies or complications after bone marrow transplantation. Forty patents died in the PICU (27% mortality rate). The most frequent indications for PICU admission were shock and respiratory disease. Of 56 children admitted with shock, there were 16 deaths (29% mortality rate). In 24 episodes of sepsis, inotropic and ventilatory support were required and 13 patients (54%) survived. Analysis of long-term survival gave estimates of 50% survival for all oncology patients admitted to the PICU and 42% for those admitted for shock.
Conclusions:
A high proportion of oncology patients admitted to the PICU requiring intensive intervention survive and go on to be cured of their malignancy. Our study suggests the PICU outcome for these patients has improved.