J Pediatr Intensive Care
DOI: 10.1055/s-0044-1778724
Sarah Nostedt
1
Division of Pediatric Critical Care, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
,
Ruchi Sinha
2
Pediatric Critical Care, Imperial College Healthcare NHS Trust, London, United Kingdom
,
1
Division of Pediatric Critical Care, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
,
Leah Szadkowski
3
Biostatistics Research Unit, Toronto General Hospital, Toronto, Ontario, Canada
,
Catherine Farrell
4
Pediatric Critical Care, CHU Sainte-Justine, Montreal, Quebec, Canada
,
Chris Parshuram
5
Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
6
Child Health Evaluative Sciences Program and Center for Safety Research. SickKids Research Institute, Toronto, Ontario, Canada
7
Interdepartmental Division of Critical Care, Department of Pediatrics and Institute of Medical Science, Institute of Health Policy Management and Evaluation, Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada
› Author Affiliations
Funding This work was in part funded by an unrestricted grant from the Gluskin Sheff and Associates Pediatric Critical Care Research Endowment. The funding agency had no role in the design, conduct, interpretation, or decision to publish this work.
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Abstract
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.
Keywords
pediatric critical care -
pediatric intensive care -
leukemia -
lymphoma -
mortality -
oncology
Publication History
Received: 10 July 2023
Accepted: 20 December 2023
Article published online:
01 March 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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