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PICU mortality of children with cancer admitted to pediatric intensive care unit : a systematic review and meta-analysis

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Abstract
Background: Outcomes for children diagnosed with cancer have improved dramatically over the past 20 years. However, although 40% of pediatric cancer patients require at least one intensive care admission throughout their disease course, PICU outcomes and resource utilization by this population have not been rigorously studied in this specific group. Methods: Using a systematic strategy, we searched Medline, Embase, and CINAHL databases for articles describing PICU mortality of pediatric cancer patients admitted to PICU. Two investigators independently applied eligibility criteria, assessed data quality, and extracted data. We pooled PICU mortality estimates using random-effects models and examined mortality trends over time using meta-regression models. Results: Out of 1218 identified manuscripts, 31 studies were included covering 16,853 PICU admissions with the majority being retrospective in nature. Overall pooled weighted mortality was 27.8% (95% confidence interval (CI), 23.7-31.9%). Mortality decreased slightly over time when post-operative patients were excluded. The use of mechanical ventilation (odds ratio (OR): 18.49 [95% CI 13.79-24.78], p < 0.001), inotropic support (OR: 14.05 [95% CI 9.16-21.57], p < 0.001), or continuous renal replacement therapy (OR: 3.24 [95% CI 1.31-8.04], p = 0.01) was significantly associated with PICU mortality. Conclusions: PICU mortality rates of pediatric cancer patients are far higher when compared to current mortality rates of the general PICU population. PICU mortality has remained relatively unchanged over the past decades, a slight decrease was only seen when post-operative patients were excluded. This compared infavorably with the improved mortality seen in adults with cancer admitted to ICU, where research-led improvements have led to the paradigm of unlimited, aggressive ICU management without any limitations on resuscitations status, for a time-limited trial.
Keywords
Pediatric intensive care units, Cancer, Mortality, STEM-CELL TRANSPLANTATION, RESPIRATORY-DISTRESS-SYNDROME, CRITICALLY-ILL PATIENTS, ONCOLOGY PATIENTS, PROGNOSTIC-FACTORS, IMPROVED OUTCOMES, RISK-FACTORS, ADMISSION, MALIGNANCY, ADOLESCENTS

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MLA
Wösten-van Asperen, Roelie M., et al. “PICU Mortality of Children with Cancer Admitted to Pediatric Intensive Care Unit : A Systematic Review and Meta-Analysis.” CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY, vol. 142, 2019, pp. 153–63.
APA
Wösten-van Asperen, R. M., van Gestel, J. P., van Grotel, M., Tschiedel, E., Dohna-Schwake, C., Valla, F. V., … Brierley, J. (2019). PICU mortality of children with cancer admitted to pediatric intensive care unit : a systematic review and meta-analysis. CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY, 142, 153–163.
Chicago author-date
Wösten-van Asperen, Roelie M, Josephus PJ van Gestel, Martine van Grotel, Eva Tschiedel, Christian Dohna-Schwake, Frédéric V Valla, Jef Willems, et al. 2019. “PICU Mortality of Children with Cancer Admitted to Pediatric Intensive Care Unit : A Systematic Review and Meta-Analysis.” CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY 142: 153–63.
Chicago author-date (all authors)
Wösten-van Asperen, Roelie M, Josephus PJ van Gestel, Martine van Grotel, Eva Tschiedel, Christian Dohna-Schwake, Frédéric V Valla, Jef Willems, Jeppe S Angaard Nielsen, Martin F Krause, Jenny Potratz, Marry M van den Heuvel-Eibrink, and Joe Brierley. 2019. “PICU Mortality of Children with Cancer Admitted to Pediatric Intensive Care Unit : A Systematic Review and Meta-Analysis.” CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY 142: 153–163.
Vancouver
1.
Wösten-van Asperen RM, van Gestel JP, van Grotel M, Tschiedel E, Dohna-Schwake C, Valla FV, et al. PICU mortality of children with cancer admitted to pediatric intensive care unit : a systematic review and meta-analysis. CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY. 2019;142:153–63.
IEEE
[1]
R. M. Wösten-van Asperen et al., “PICU mortality of children with cancer admitted to pediatric intensive care unit : a systematic review and meta-analysis,” CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY, vol. 142, pp. 153–163, 2019.
@article{8625210,
  abstract     = {Background: Outcomes for children diagnosed with cancer have improved dramatically over the past 20 years. However, although 40% of pediatric cancer patients require at least one intensive care admission throughout their disease course, PICU outcomes and resource utilization by this population have not been rigorously studied in this specific group. 
Methods: Using a systematic strategy, we searched Medline, Embase, and CINAHL databases for articles describing PICU mortality of pediatric cancer patients admitted to PICU. Two investigators independently applied eligibility criteria, assessed data quality, and extracted data. We pooled PICU mortality estimates using random-effects models and examined mortality trends over time using meta-regression models. 
Results: Out of 1218 identified manuscripts, 31 studies were included covering 16,853 PICU admissions with the majority being retrospective in nature. Overall pooled weighted mortality was 27.8% (95% confidence interval (CI), 23.7-31.9%). Mortality decreased slightly over time when post-operative patients were excluded. The use of mechanical ventilation (odds ratio (OR): 18.49 [95% CI 13.79-24.78], p < 0.001), inotropic support (OR: 14.05 [95% CI 9.16-21.57], p < 0.001), or continuous renal replacement therapy (OR: 3.24 [95% CI 1.31-8.04], p = 0.01) was significantly associated with PICU mortality. 
Conclusions: PICU mortality rates of pediatric cancer patients are far higher when compared to current mortality rates of the general PICU population. PICU mortality has remained relatively unchanged over the past decades, a slight decrease was only seen when post-operative patients were excluded. This compared infavorably with the improved mortality seen in adults with cancer admitted to ICU, where research-led improvements have led to the paradigm of unlimited, aggressive ICU management without any limitations on resuscitations status, for a time-limited trial.},
  author       = {Wösten-van Asperen, Roelie M and van Gestel, Josephus PJ and van Grotel, Martine and Tschiedel, Eva and Dohna-Schwake, Christian and Valla, Frédéric V and Willems, Jef and Angaard Nielsen, Jeppe S and Krause, Martin F and Potratz, Jenny and van den Heuvel-Eibrink, Marry M and Brierley, Joe},
  issn         = {1040-8428},
  journal      = {CRITICAL REVIEWS IN ONCOLOGY HEMATOLOGY},
  keywords     = {Pediatric intensive care units,Cancer,Mortality,STEM-CELL TRANSPLANTATION,RESPIRATORY-DISTRESS-SYNDROME,CRITICALLY-ILL PATIENTS,ONCOLOGY PATIENTS,PROGNOSTIC-FACTORS,IMPROVED OUTCOMES,RISK-FACTORS,ADMISSION,MALIGNANCY,ADOLESCENTS},
  language     = {eng},
  pages        = {153--163},
  title        = {PICU mortality of children with cancer admitted to pediatric intensive care unit : a systematic review and meta-analysis},
  url          = {http://dx.doi.org/10.1016/j.critrevonc.2019.07.014},
  volume       = {142},
  year         = {2019},
}

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