Both authors: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
Pediatr Crit Care Med. 2024 Jan 1;25(1):e52-e58. doi: 10.1097/PCC.0000000000003380. Epub 2023 Oct 9.
To determine changes in pediatric oncology hospitalizations requiring intensive care over the period 2012-2021.
Retrospective study of hospital admission.
Registry data from 36 children's hospitals in the U.S. Pediatric Health Information Systems database.
Children 18 years or younger admitted to any of 36 hospitals with an oncology diagnosis.
None.
There were a total of 55,827 unique patients accounted for 281,221 pediatric oncology hospitalizations over the 10-year period, and 16.6% of hospitalizations included admission to the PICU. Hospitalizations and PICU admissions steadily increased over this decade. Between 2012 and 2016, 15.1% of oncology hospitalizations were admitted to the PICU compared with 18.0% from 2017 to 2021 (difference 2.9% [95% CI, 2.6-3.2%] p ≤ 0.0001). Support with invasive mechanical ventilation also increased over time with 3.7% during 2012-2016 compared with 4.1% from 2017 to 2021 (difference 0.4% [95% CI, 0.2-0.5%] p ≤ 0.0001). Similar results were seen with cardiorespiratory life support using extracorporeal membrane oxygenation (difference 0.05% [95% CI, 0.02-0.07%] p = 0.0002), multiple vasoactive agent use (difference 0.3% [95% CI, 0.2-0.4%] p < 0.0001), central line placement (difference 5.3% [95% CI, 5.1-5.6%], p < 0.001), and arterial line placement (difference 0.4% [95% CI, 0.3-0.4%], p < 0.001). Year-on-year case fatality rate was unchanged over time (1.3%), but admission to the PICU during the second 5 years, compared with the first 5 years, was associated with lower odds of mortality (difference 0.7% [95% CI, 0.3-1.1%]) (odds ratio 0.82 [95% CI, 0.75-0.90%] p < 0.001).
The percentage of pediatric oncology hospitalizations resulting in PICU admission has increased over the past 10 years. Despite the increasing use of PICU admission and markers of acuity, and on comparing 2017-2021 with 2012-2016, there are lower odds of mortality.
确定 2012 年至 2021 年期间，儿科肿瘤住院患者需要重症监护的变化情况。
医院入院的回顾性研究。
美国儿童健康信息系统数据库 36 家儿童医院的登记数据。
18 岁或以下，被诊断为患有肿瘤的患者。
无。
10 年内共有 55827 名独特患者，总计 281221 例儿科肿瘤住院治疗，其中 16.6%的住院患者包括入住儿科重症监护病房（PICU）。在这十年中，住院人数和 PICU 入院人数稳步增加。2012 年至 2016 年期间，15.1%的肿瘤住院患者入住 PICU，而 2017 年至 2021 年期间为 18.0%（差异 2.9%[95%CI，2.6-3.2%]p≤0.0001）。随着时间的推移，使用有创机械通气的支持也在增加，2012-2016 年为 3.7%，而 2017-2021 年为 4.1%（差异 0.4%[95%CI，0.2-0.5%]p≤0.0001）。使用体外膜氧合（ECMO）的心肺生命支持也有类似的结果（差异 0.05%[95%CI，0.02-0.07%]p=0.0002）、使用多种血管活性药物（差异 0.3%[95%CI，0.2-0.4%]p<0.0001）、中央静脉置管（差异 5.3%[95%CI，5.1-5.6%]p<0.001）和动脉置管（差异 0.4%[95%CI，0.3-0.4%]p<0.001）。逐年病死率保持不变（1.3%），但与前 5 年相比，第 2 个 5 年期间的 PICU 入院与较低的死亡率相关（差异 0.7%[95%CI，0.3-1.1%]）（优势比 0.82[95%CI，0.75-0.90%]p<0.001）。
在过去 10 年中，儿科肿瘤住院患者中需要入住 PICU 的比例有所增加。尽管 PICU 入院和疾病严重程度标志物的使用有所增加，但与 2017-2021 年相比，2012-2016 年的死亡率较低。
