TY - JOUR
T1 - Clinical and organizational risk factors for mortality during deterioration events among pediatric oncology patients in Latin America
T2 - A multicenter prospective cohort
AU - EVAT Study Group
AU - Agulnik, Asya
AU - Cárdenas, Adolfo
AU - Carrillo, Angela K.
AU - Bulsara, Purva
AU - Garza, Marcela
AU - Alfonso Carreras, Yvania
AU - Alvarado, Manuel
AU - Calderón, Patricia
AU - Díaz, Rosdali
AU - de León, Claudia
AU - del Real, Claudia
AU - Huitz, Tania
AU - Martínez, Angélica
AU - Miralda, Scheybi
AU - Montalvo, Erika
AU - Negrín, Octavia
AU - Osuna, Alejandra
AU - Perez Fermin, Clara Krystal
AU - Pineda, Estuardo
AU - Soberanis, Dora
AU - Juárez Tobias, Maria Susana
AU - Lu, Zhaohua
AU - Rodriguez-Galindo, Carlos
AU - Covarrubias, Daniela
AU - Pérez, Gabriela
AU - Cahuich, Deysi
AU - Echavarría, Maite
AU - Cabreros, Lety
AU - Tostado, Edgardo
AU - Méndez, Alejandra
AU - Mack, Ricardo
AU - Michel, Carmitude
AU - Raydmound, Madonie
AU - Altamirano, Eduardo
AU - Castillo, Faviola
AU - Morales, Roxana
AU - Villasante, Carlos
AU - Pérez, Esmenia
AU - Carpio, Zulma
AU - Obando, Grania
AU - Alguera, Sabrina
AU - Alvarado, Angela
AU - Jirón, Reyna
AU - Quintero, Karina
AU - Miller, Kenia
AU - de Rosas, Almida
AU - Ceballo, Gloria
AU - Gómez, Hercilia
AU - Rivera, Jocelyn
AU - Alejo Zapata, Francisco Domingo
N1 - Publisher Copyright:
© 2021 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.
PY - 2021/5/15
Y1 - 2021/5/15
N2 - Background: Hospitalized pediatric hematology-oncology (PHO) patients have frequent clinical deterioration events (CDE) requiring intensive care unit (ICU) admission, particularly in resource-limited settings. The objective of this study was to describe CDEs in hospitalized PHO patients in Latin America and to identify event-level and center-level risk factors for mortality. Methods: In 2017, the authors implemented a prospective registry of CDEs, defined as unplanned transfers to a higher level of care, use of ICU-level interventions on the floor, or nonpalliative floor deaths, in 16 PHO centers in 10 countries. PHO hospital admissions and hospital inpatient days were also reported. This study analyzes the first year of registry data (June 2017 to May 2018). Results: Among 16 centers, 553 CDEs were reported in PHO patients during 11,536 admissions and 119,414 inpatient days (4.63 per 1000 inpatient days). Event mortality was 29% (1.33 per 1000 inpatient days) but ranged widely across centers (11%-79% or 0.36-5.80 per 1000 inpatient days). Significant risk factors for event mortality included requiring any ICU-level intervention on the floor and not being transferred to a higher level of care. Events with organ dysfunction, a higher severity of illness, and a requirement for ICU intervention had higher mortality. In center-level analysis, hospitals with a higher volume of PHO patients, less floor use of ICU intervention, lower severity of illness on transfer, and lower rates of floor cardiopulmonary arrest had lower event mortality. Conclusions: Hospitalized PHO patients who experience CDEs in resource-limited settings frequently require floor-based ICU interventions and have high mortality. Modifiable hospital practices around the escalation of care for these high-risk patients may contribute to poor outcomes. Earlier recognition of critical illness and timely ICU transfer may improve survival in hospitalized children with cancer.
AB - Background: Hospitalized pediatric hematology-oncology (PHO) patients have frequent clinical deterioration events (CDE) requiring intensive care unit (ICU) admission, particularly in resource-limited settings. The objective of this study was to describe CDEs in hospitalized PHO patients in Latin America and to identify event-level and center-level risk factors for mortality. Methods: In 2017, the authors implemented a prospective registry of CDEs, defined as unplanned transfers to a higher level of care, use of ICU-level interventions on the floor, or nonpalliative floor deaths, in 16 PHO centers in 10 countries. PHO hospital admissions and hospital inpatient days were also reported. This study analyzes the first year of registry data (June 2017 to May 2018). Results: Among 16 centers, 553 CDEs were reported in PHO patients during 11,536 admissions and 119,414 inpatient days (4.63 per 1000 inpatient days). Event mortality was 29% (1.33 per 1000 inpatient days) but ranged widely across centers (11%-79% or 0.36-5.80 per 1000 inpatient days). Significant risk factors for event mortality included requiring any ICU-level intervention on the floor and not being transferred to a higher level of care. Events with organ dysfunction, a higher severity of illness, and a requirement for ICU intervention had higher mortality. In center-level analysis, hospitals with a higher volume of PHO patients, less floor use of ICU intervention, lower severity of illness on transfer, and lower rates of floor cardiopulmonary arrest had lower event mortality. Conclusions: Hospitalized PHO patients who experience CDEs in resource-limited settings frequently require floor-based ICU interventions and have high mortality. Modifiable hospital practices around the escalation of care for these high-risk patients may contribute to poor outcomes. Earlier recognition of critical illness and timely ICU transfer may improve survival in hospitalized children with cancer.
KW - clinical deterioration
KW - intensive care
KW - Latin America
KW - Pediatric Early Warning Systems (PEWS)
KW - pediatric oncology
KW - resource-limited settings
UR - http://www.scopus.com/inward/record.url?scp=85104981058&partnerID=8YFLogxK
U2 - 10.1002/cncr.33411
DO - 10.1002/cncr.33411
M3 - Artículo
C2 - 33524166
AN - SCOPUS:85104981058
VL - 127
SP - 1668
EP - 1678
JO - Cancer
JF - Cancer
SN - 0008-543X
IS - 10
ER -