LATEST DEVELOPMENTS IN TREATING CHILDREN WITH HAEMATO-ONCOLOGIC DISORDERS
OUTCOMES IN ONCOLOGY PATIENTS IN THE PICU
RISK FACTORS FOR MORTALITY OF ONCOLOGY PATIENTS ADMITTED TO THE PAEDIATRIC INTENSIVE CARE UNIT: A SINGLE CENTRE RETROSPECTIVE STUDY
Abstract
Background
Oncology patients admitted to the paediatric intensive care unit (PICU) are at high risk of mortality.
Objectives
This study aims to describe the risk factors for mortality in these patients.
Methods
This retrospective study included all PICU oncology admissions from 2011-2017. Clinical and laboratory data were extracted. Primary outcome was PICU mortality. PICU survivors and non-survivors were compared, using Chi-squared and Wilcoxson rank-sum tests as deemed appropriate. Covariates included in the multivariable logistic regression for mortality included: type of admissions, previous bacteraemia and PRISM (Paediatric Risk of Mortality) III scores.
Results
Of 200 patients identified, the most common diagnoses were brain tumours (73/200, 36.5%) and acute lymphoblastic leukaemia (36/200, 18.0%). Median age and PRISM III scores were 7 (3, 12) years and 3 (0, 5) respectively. Septic shock was the main reason for emergent admissions (25/97, 25.8%). Overall mortality was 18/200 (9.0%). Mortality was higher in emergent cases than elective cases [17/97, 17.5% vs 1/103, 0.9%, p<0.001], in those with active bacteraemia [6/25, 24.0% vs 12/175, 6.9%, p<0.001], previous bacteraemia [10/35, 28.6% vs 8/165, 4.8%, p<0.001] and neutropenia [7/37, 18.9% vs 11/163, 6.7%, p=0.020] compared to those without. Independent risk factors for mortality were emergent admissions (adjusted odds ratio [aOR]: 10.3, (95% confidence interval [CI]: 1.26, 84.03); p=0.030) previous bacteraemia (aOR: 3.3, (95% CI: 1.06, 10.38); p=0.039) and higher PRISM III scores (aOR: 1.2, (95% CI: 1.02, 1.29); p=0.021).
Conclusion
Emergent PICU admissions, previous bacteraemia and higher PRISM III scores were independent risk factors for mortality in our centre.
CLINICAL AND EPIDEMIOLOGICAL PROFILE OF CHILDREN WITH HYDROCEPHALUS
Abstract
Background
Hydrocephalus is a multifactorial disease that occurs predominantly in childhood, causing functional and neuropsychological abnormalities, determining impact for children, family members and health professionals.
Objectives
To analyze the clinical and epidemiological profile of children with hydrocephalus in a children’s neurosurgery outpatient clinic of a university hospital.
Methods
Cross-sectional study using nonprobability sampling methods. Conducted in 2018 in the Children’s Neurosurgery Outpatient Clinic of a university hospital, Brazil. We included children with hydrocephalus between 01 month and 15 years old.
Results
We enrolled 32 children, 16 girls and 16 boys; with mean age of 4.4 ± 3.9 years. First shunt was done at 1.27 ± 3.06 years. The causes of hydrocephalus were: spina bifida (35.5%), neonatal brain hemorrhage (22.6%), neoplasms (12.9%), and others (28.8%). Considering all shunts and shunt reviews, there was an average of 1.58 ± 3.06 surgical proceedings for each patient. Twenty (62%) patients presented complications, including infection in 8 (25%), and shunt malfunction in 12 (37%). We found no association between the causes of hydrocephalus and the number of surgeries (p = 0.072), and between the causes of hydrocephalus and shunt dysfunction/infections (p = 0.394).
Conclusion
This study contributes to characterize the evolution and treatment of hydrocephalus in our community, producing basis to make comparisons with the literature and other services.
Presentation files
HideCRITICAL INCIDENTS: THE REALITY OF A PEDIATRIC INTENSIVE CARE UNIT IN
THE LAST TEN YEARS
Abstract
Background
A critical incident (CI) is an event or circumstance that caused or could have caused (such as a near miss) unplanned harm, suffering or loss to a patient. The study of CIs in intensive care units (ICU) is crucial to improve healthcare quality.
Objectives
To determine the incidence, type and outcomes of CI in a level III Pediatric ICU over a ten-year period (2008-2018).
Methods
Descriptive and quantitative study. Retrospective review of all CI notification forms (filled voluntarily and anonymously). Statistical analysis using SPSS® (v21, p<0,05).
Results
A total of 968 CIs were reported (34-147 per year). The main categories were: 41,7% medication (50,7% in prescription; 27,7% in administration); 17,5% airway/ventilation (64,3% in security - 88,9% of these related to accidental extubation); 12,7% procedures/techniques. The majority (64%) of CIs affected the patient and 16% of these resulted in harm. In 80% of cases, the occupation rate of ICU was equal to or above 50% and 25% occurred during the night shift. The CIs concerning ventilation were associated with greater severity, recurrence and harm to the patient (p<0,05). A higher occupation rate was also associated with greater severity (p<0,05). A total of 132 clinical recommendations were written and implemented in order to minimize the occurrence of CI.
Conclusion
CI related to medication and ventilation were the most prevalent, in line with the published literature. Notification, analysis and periodic discussion of CI are very important in order to prevent recurrence of these events.
PREVALENCE OF ANAEMIA AT DISCHARGE FROM CANADIAN AND UK PICUS
Abstract
Background
While restrictive red cell transfusion strategies in PICU may not impact PICU outcomes, they may add to the burden of anemia at discharge. The consequence of anemia on the longer-term outcomes in this cohort are not known. We aimed to describe the burden of anemia at discharge in 2 PICUs in Canada and the UK.
Objectives
The objective of this study was to determine the prevalence of anaemia at PICU discharge.
Methods
This is a retrospective cohort study of consecutive PICU survivors over 5 years in a Canadian PICU (January 2013-January 2018) and 2.5 years in a UK PICU (July 2015-January 2018). Patient characteristics and the last hemoglobin (Hb) level prior to PICU discharge were collected from the electronic health record. Children with a corrected gestational age <37 weeks were excluded. Anemia was defined as per the Canadian Blood Services diagnostic criteria. The chi-square test was used to test the association between anemia and age.
Results
There were 5027 admissions to the Canadian and 2216 admissions to the UK PICU in the study period; 4890/5027 (97.3%) and 2097/2216 (94.6%) survived respectively. Hb values prior to discharge were available for 6210/6987 (88.8%) admissions; 3185/6210 (51.3%) were found to be anaemic prior to discharge. Children above 6 months were more likely to be anaemic.
Conclusion
Conclusions: Anaemia is common at PICU discharge. The long-term consequences of anemia in these children is unknown and needs to be further investigated.