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Clinical and organizational risk factors for mortality during deterioration events among pediatric oncology patients in Latin America: A multicenter prospective cohort

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dc.contributor.authorAgulnik, Asya
dc.contributor.authorCárdenas, Adolfo
dc.contributor.authorCarrillo, Angela K
dc.contributor.authorBulsara, Purva
dc.contributor.authorGarza, Marcela
dc.contributor.authorAlfonso Carreras, Yvania
dc.contributor.authorAlvarado, Manuel
dc.contributor.authorCalderón, Patricia
dc.contributor.authorDíaz, Rosdali
dc.contributor.authorde León, Claudia
dc.contributor.authorDel Real, Claudia
dc.contributor.authorHuitz, Tania
dc.contributor.authorMartínez, Angélica
dc.contributor.authorMiralda, Scheybi
dc.contributor.authorMontalvo, Erika
dc.contributor.authorNegrín, Octavia
dc.contributor.authorOsuna, Alejandra
dc.contributor.authorPerez Fermin, Clara Krystal
dc.contributor.authorPineda, Estuardo
dc.contributor.authorSoberanis, Dora
dc.contributor.authorJuárez Tobias, Maria Susana
dc.contributor.authorLu, Zhaohua
dc.contributor.authorRodriguez-Galindo, Carlos
dc.contributor.authorEVAT Study Group
dc.date.accessioned2024-08-15T13:24:53Z
dc.date.available2024-08-15T13:24:53Z
dc.date.issued2021
dc.description.abstractBackground 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. Keywords: clinical deterioration, intensive care, Latin America, pediatric oncology, Pediatric Early Warning Systems (PEWS), resource‐limited settings
dc.identifier.citationAgulnik A, Cárdenas A, Carrillo AK, Bulsara P, Garza M, Alfonso Carreras Y, Alvarado M, Calderón P, Díaz R, de León C, Del Real C, Huitz T, Martínez A, Miralda S, Montalvo E, Negrín O, Osuna A, Perez Fermin CK, Pineda E, Soberanis D, Juárez Tobias MS, Lu Z, Rodriguez-Galindo C; EVAT Study Group. Clinical and organizational risk factors for mortality during deterioration events among pediatric oncology patients in Latin America: A multicenter prospective cohort. Cancer. 2021 May 15;127(10):1668-1678. doi: 10.1002/cncr.33411. Epub 2021 Feb 1. PMID: 33524166; PMCID: PMC8248122.
dc.identifier.urihttp://biblioteca.solcaquito.org.ec:9997/handle/123456789/1573
dc.language.isoen
dc.titleClinical and organizational risk factors for mortality during deterioration events among pediatric oncology patients in Latin America: A multicenter prospective cohort
dc.typeArticle
dspace.entity.typePublication
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