Critical Care Utilization in Children With Cancer: U.S. Pediatric Health Information System Database Cohort 2012–2021

Abstract

OBJECTIVES: To determine changes in pediatric oncology hospitalizations requiring intensive care over the period 2012–2021. DESIGN: Retrospective study of hospital admission. SETTING: Registry data from 36 children’s hospitals in the U.S. Pediatric Health Information Systems database. PATIENTS: Children 18 years or younger admitted to any of 36 hospitals with an oncology diagnosis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: 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). CONCLUSIONS: 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.