Aim Recent advances in management of paediatric malignancy have resulted in improved survival. However, intensive treatment may necessitate PICU support. The aim of this study was to clarify which patients require admission to PICU, why and what happens to them?
Methods A retrospective analysis of the PICU electronic database was performed. Patients from the haemato-oncology parent group admitted during a 5 year period (1st April 2006 - 1st April 2011) were identified but those with benign conditions were excluded. The records for each admission were then analysed and data extracted using a standard proforma.
Results 96 patients were admitted 151 times during the 5 year period. 30 patients (42 admissions) were elective post op admissions for observation only and all were discharged to the ward within 36 hrs.
77 patients had 109 admissions for acute illness. Presumed sepsis was the main (44%) reason for admission with a further 10% due to pneumonia, 6% due to reduced conscious level, 6% with myocardial compromise and 3% with seizures. ALL was responsible for 39% admissions, AML 27%, neuroblastoma 10%, lymphoma 9% and brain tumours 5% with 9% suffering other malignancies. Half (48%) of the admissions required invasive ventilation, 42% necessitated inotropic support and 6% renal support. The length of stay ranged from 3 to 1100 hrs. 70% of the admissions were discharged to the ward, 15% were discharged but readmitted to PICU within a month, 9% resulted in death within PICU, 2% died within 1 month of PICU discharge and 3% were discharged for palliative care. 3% of admissions were transferred to another more specialist hospital.
Conclusion Two distinct groups (elective post op and acute unplanned) of children with malignancy are admitted to the ICU. Leukaemia is over-represented occurring in almost 2/3 of the acute admissions and is associated with a higher mortality. Sepsis is the major reason for acute admission and the course and intervention required can be very variable. Mortality following acute admission is 9% in unit and 14% within 1 month which is an improvement compared to previous literature.