title: Intensive care unit admission in children with malignant or nonmalignant disease: incidence, outcome, and prognostic factors: a single-center experience.
abstract: OBJECTIVE
  To investigate pediatric intensive care unit (PICU) admission in children with malignant and nonmalignant diseases who developed life-threatening complications.
  
  
  METHODS
  Between 1999 and 2010, of the 1278 eligible pediatric patients treated for a malignant or nonmalignant disease, 54 were admitted to the PICU for respiratory distress (40.7%), neurological events (33.3%), severe sepsis (14.8%), and organ failure (11.2%).
  
  
  RESULTS
  Rate of PICU admission was 4.2%, with a 2-year cumulative incidence of 4.5%. Risk factors associated with higher cumulative incidence of PICU admission were older age at study entry (P=0.003), nonmalignant underlying disease (P=0.015), and hematopoietic stem cell transplantation (P<0.001). Patients with leukemia/lymphoma were more likely to be admitted to the PICU compared with patients with solid tumors (P<0.001). Patients admitted because of organ failure had the highest frequency of death within 90 days. Factors significantly associated with survival at 90 days from PICU admission included: no mechanical ventilation (P<0.001), nonmalignant underlying disease (P=0.030), and year of PICU admission after 2005 (P=0.038).
  
  
  CONCLUSIONS
  Nonmalignant disease and use of alternative hematopoietic stem cell transplantation were associated with higher risk of PICU admission. Close cooperation between hematologists and intensivists and definition of criteria for PICU admission and discharge contributed to increase in survival of these patients.
authors.affiliation: *Hematology-Oncology Department-Stem Cell Transplantation Section †Epidemiology and Biostatistics Section, Scientific Directorate ‡Infectious Diseases Unit §Neonatal and Pediatric Intensive Care Unit, G. Gaslini Research Institute, Genoa, Italy ∥Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Maura
authors.initials: M
authors.lastname: Faraci
authors.forename: Francesca
authors.initials: F
authors.lastname: Bagnasco
authors.forename: Stefano
authors.initials: S
authors.lastname: Giardino
authors.forename: Massimo
authors.initials: M
authors.lastname: Conte
authors.forename: Concetta
authors.initials: C
authors.lastname: Micalizzi
authors.forename: Elio
authors.initials: E
authors.lastname: Castagnola
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Lampugnani
authors.forename: Andrea
authors.initials: A
authors.lastname: Moscatelli
authors.forename: Alessia
authors.initials: A
authors.lastname: Franceschi
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Carcillo
authors.forename: Riccardo
authors.initials: R
authors.lastname: Haupt
mesh_terms: D000293:Adolescent; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D019337:Hematologic Neoplasms / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology* / Q000401:mortality; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000401:mortality; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D055815:Young Adult