(315) Pediatric Oncology and Bone Marrow Transplant ICU Care in Children's Versus Community Hospitals

Introduction: Pediatric oncology and bone marrow transplant (BMT) care is increasingly provided at children’s hospitals (CH), but many children still receive care at general hospitals. Little is known about ICU care for pediatric oncology and BMT patients at non-CHs, or how outcomes differ for patients treated in CH and non-CH ICUs. We evaluated associations between hospital type and ICU admissions and outcomes for pediatric oncology and BMT patients in the U.S. from 2001-2019, hypothesizing that ICU admission, organ dysfunction, and mortality would be higher in CHs.

Methods: We used the Healthcare Cost and Utilization Project’s State Inpatient Databases from a total of 21 U.S. states in 2001, 2004, 2010, 2016, and 2019 and included all oncology and HCT patients aged 0-17 years. We used ICD-9 and 10 codes to identify diagnoses, organ failure, and mortality and American Hospital Association linkage files to identify hospital type. We used generalized linear Poisson regression to evaluate changes from 2001-2019.

Results: Of 86,304 hospitalized pediatric oncology and BMT patients, admission to CHs rose from 61.5% in 2001 to 93.5% in 2019. From 2001-2019, ICU admission prevalence among oncology patients decreased from 14.1% to 13.3% in CHs but increased from 13.6% to 14.5% in non-CHs. ICU admission prevalence for BMT patients decreased from 33.7% to 18.1% in CHs while increasing from 14.0% to 40.5% in non-CHs. ICU admission prevalence rose with increasing distance from home for both CHs and non-CHs (14.8% for < 15 miles to 18.9% for >100 miles in 2019). Prevalence of organ failure among oncology and BMT patients rose from 40.3% to 64.2% from 2001 to 2019 (RR 1.59 [95% CI 1.43-1.78]) in CH ICUs and from 33.7% to 55.2% (RR 1.64 [95% CI 1.27-2.12]) in non-CH ICUs. BMT patients experienced multiple organ dysfunction more frequently over time in CH ICUs (17.1% to 40.8%) than non-CH ICUs (17.1% to 28.6%). Hospital mortality decreased in CH ICUs (6.9% to 5.3%) at a slower rate than in non-CH ICUs (6.1% to 2.8%).

Conclusions: Many pediatric oncology and BMT patients receive care in community hospitals and experience higher rates of ICU admission than in CHs with high prevalence of organ dysfunction and mortality. Ensuring adequate access to specialized care will be essential to improve outcomes in these patients.