title: Should We Pay Attention to the Delay Before Admission to a Pediatric Intensive Care Unit for Children With Cancer? Impact on 1-Month Mortality. A Report From the French Children's Oncology Study Group, GOCE.
abstract: Acute complications requiring admission to pediatric intensive care unit (PICU) are frequent for children with cancer. Our objective was to determine early prognostic factors of mortality in a cohort of children with cancer hospitalized in PICU for acute complications and particularly to assess whether the delay before admission to a PICU is an early predictor of mortality. We conduct a retrospective multicenter analysis. All patients transferred in PICU for acute complications between January 2002 and December 2012 were included. One-month mortality of the 224 patients analyzed was 24.5%. Delay before PICU admission was a significant prognostic factor of 1-month mortality with nonsurvivors experiencing a longer median delay than survivors (24 vs. 12 h, respectively, P<0.05). Time from diagnosis to PICU admission (P<0.001), hematopoietic stem cell transplant (P<0.05), the duration of neutropenia (P<0.01), infection type (P<0.001), number of organ dysfunctions (P<0.001), and reaching any grade 4 toxicity before PICU admission (P<0.001) also affected mortality rate at 1-month post-PICU discharge. In the multivariate analysis, only reaching any grade 4 toxicity before PICU admission influenced 1-month mortality (odds ratio, 2.30; 95% confidence interval, 1.07-4.96; P<0.05). These results suggest that PICU admission before severe impairment leads to a better outcome for children with cancer.
authors.affiliation: Departments of *Pediatric and Adolescent Medicine #Anesthesiology and Intensive Care, Division of Pediatric Intensive Care †GOCE Biostatistic Unit ††Department of Pediatric Hematology/Oncology, University Hospital of Rennes, Rennes 1 University ‡Department of Pediatric Hematology/Oncology, University Hospital of Nantes §Department of Pediatric Hematology/Oncology, University Hospital of Brest ∥Department of Pediatric Hematology/Oncology, University Hospital of Caen ¶Department of Pediatric Hematology/Oncology, University Hospital of Tours **Department of Pediatric Hematology/Oncology, University Hospital of Angers, France.
authors.forename: Jeanne-L
authors.initials: JL
authors.lastname: Fausser
authors.forename: Aude
authors.initials: A
authors.lastname: Tavenard
authors.forename: Fanny
authors.initials: F
authors.lastname: Rialland
authors.forename: Philippe
authors.initials: P
authors.lastname: Le Moine
authors.forename: Odile
authors.initials: O
authors.lastname: Minckes
authors.forename: Anne
authors.initials: A
authors.lastname: Jourdain
authors.forename: Olivier
authors.initials: O
authors.lastname: Tirel
authors.forename: Isabelle
authors.initials: I
authors.lastname: Pellier
authors.forename: Virginie
authors.initials: V
authors.lastname: Gandemer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000401:mortality*; D010343:Patient Admission; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult