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Outcome of oncology patients in the pediatric intensive care unit
Y Sivan1, P H Schwartz, T Schonfeld
1Pediatric Intensive Care Unit, Beilinson Medical Center, Petah Tikva, Israel.
Insights
Pediatric cancer patients admitted to the Pediatric Intensive Care Unit (PICU) have a high mortality rate, especially those with acute organ system failure. Current scoring systems may not accurately predict outcomes for these critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Pediatric Oncology
- Intensive Care Medicine
Background:
- Pediatric Intensive Care Units (PICUs) manage critically ill children, including those with cancer.
- Assessing the severity of illness and quantity of care is crucial for understanding outcomes in PICU admissions.
- Pediatric cancer patients represent a vulnerable population with unique critical care needs.
Purpose of the Study:
- To evaluate the outcomes of oncology patients admitted to the PICU.
- To assess the correlation between severity of illness, quantity of care, and mortality in this patient group.
- To identify factors associated with poor outcomes in pediatric cancer patients requiring intensive care.
Main Methods:
- Retrospective analysis of 72 consecutive oncology patient admissions to a PICU.
- Measurement of illness severity using the Physiologic Stability Index (PSI).
- Quantification of care intensity using the Therapeutic Intervention Scoring System (TISS).
Main Results:
- Overall mortality was 51%, with 66% mortality in patients admitted for acute organ system failure (OSF).
- Acute respiratory failure was the most common OSF and reason for PICU admission.
- Severe leucopenia, acute renal failure, and central nervous system deterioration were associated with high mortality rates (91%, 94%, and 83%, respectively).
- Observed mortality exceeded predicted mortality for patients with a PSI > 5, indicating limitations in current predictive algorithms.
Conclusions:
- Pediatric cancer patients admitted to the PICU experience high mortality rates.
- Specific complications like acute organ system failure and certain laboratory/clinical findings predict poor outcomes.
- Existing scoring systems require improvement for accurate outcome prediction in this specific population.
Abstract:
We evaluated the outcome of oncology patients in the Pediatric Intensive Care Unit (PICU) from a total of 72 consecutive admissions. Severity of illness and quantity of care were measured by the Physiologic Stability Index (PSI) and the Therapeutic Intervention Scoring System (TISS), respectively. The overall mortality was 51% and was especially high in patients admitted for acute organ system failure (OSF)-66%. Acute respiratory failure was the most frequent OSF (73%) and the most common cause for PICU admission. A poor outcome was associated with severe leucopenia (less than 1000 WBC/mm3, 91% mortality), acute renal failure (94% mortality) and central nervous system deterioration (83% mortality). When the outcome was predicted using a quantitative algorithm the observed mortality was significantly higher than the predicted for all admissions with a PSI higher than 5. Improved scoring systems are required to enable characterization of pediatric cancer patients admitted to the PICU.