MultiCenter outcome of pediatric oncology patients requiring intensive care.
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.
Dalton
Heidi J
HJ
Critical Care Medicine, Children's National Medical Center, The George Washington University School of Medicine, Washington, DC, USA.
Slonim
Anthony D
AD
Pollack
Murray M
MM
D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008297:Male; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome