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MultiCenter outcome of pediatric oncology patients requiring intensive care
Heidi J Dalton1, Anthony D Slonim, Murray M Pollack
1Critical Care Medicine, Children's National Medical Center, The George Washington University School of Medicine, Washington, DC, USA.
Insights
Pediatric cancer patients admitted to the pediatric intensive care unit (PICU) have similar survival rates and lengths of stay compared to non-cancer patients. The diagnosis of cancer should not prevent PICU admission for critically ill children.
Area of Science:
- Pediatric Intensive Care
- Pediatric Oncology
- Critical Care Medicine
Background:
- Pediatric cancer patients represent a significant population requiring intensive care.
- Previous data on outcomes for pediatric cancer patients in the pediatric intensive care unit (PICU) is limited.
- Understanding resource utilization and survival is crucial for optimizing care.
Purpose of the Study:
- To evaluate the intensive care outcomes of pediatric cancer patients.
- To compare the demographics, resource requirements, and outcomes of cancer patients with non-cancer patients in the PICU.
- To assess the impact of cancer diagnosis on PICU admission and survival.
Main Methods:
- Retrospective cohort study.
- Inclusion of 802 pediatric cancer patients from 20 PICUs.
- Comparison with non-cancer patients admitted to the PICU.
Main Results:
- Cancer patients comprised 3.3% of PICU admissions.
- Overall PICU survival was similar between cancer (95%) and non-cancer (96%) patients.
- Cancer patients were older, but had similar lengths of stay and gender distribution compared to non-cancer patients.
Conclusions:
- Pediatric cancer patients receiving intensive care generally have good outcomes.
- The diagnosis of cancer should not be a barrier to PICU admission.
- Resource utilization, specifically length of stay, is comparable between cancer and non-cancer patients in the PICU.
Abstract:
A retrospective cohort study was conducted to evaluate the intensive care outcome of pediatric cancer patients between 1996 and 1998. The study comprised 20 pediatric intensive care units (PICUs) and 802 patients with cancer requiring PICU care. Patients with a history of cancer were identified from PICUs participating in the Pediatric Intensive Care Unit Evaluations program. Their demographics, resource requirements, and outcomes were compared with those of noncancer patients. Cancer patients comprised 3.3% (802/24,431) of PICU admissions. Overall PICU survival was not different between cancer and noncancer patients (95% vs. 96%, p =.2). Cancer patients were older (99 +/- 3 vs. 72 +/- 1 months, p <.001), had similar gender distributions, and had similar lengths of stay (3.3 +/- 0.2 vs. 3.9 +/- 0.1 days, p =.98). The majority (72%) were admitted to the PICU for postoperative care; PICU survival in these patients was 100, 100, and 71% for those not receiving mechanical ventilation or vasoactive agent infusion, those receiving either mechanical ventilation or vasoactive agent infusion, and those receiving both, respectively. PICU survival in nonoperative patients was 87% overall; survival for those requiring ventilation, vasoactive infusions, or both was 93, 89 and 46%. Overall hospital survival was 99% in operative cancer patients and 81% in nonoperative patients (p =.004, operative vs. nonoperative patients). Pediatric cancer patients receiving intensive care do well overall. Outcomes have substantially improved and, in general, the diagnosis of cancer should not limit the provision of intensive care. Additionally, resource use in terms of lengths of stay in the PICU is not different between cancer and noncancer patients.