• Tracey I Wraight, Siva P Namachivayam, Matthew J Maiden, Simon J Erickson, Felix Oberender, Puneet Singh, Jye Gard, Anusha Ganeshalingham, Johnny Millar, and Australian and New Zealand Intensive Care Society Paediatric Study Group and Centre for Outcome and Resource Evaluation.
• Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia.
• Pediatr Crit Care Me. 2023 Oct 1; 24 (10): e487e497e487-e497.

ObjectivesThere are few robust, national-level reports of contemporary trends in pediatric oncology admissions, resource use, and mortality. We aimed to describe national-level data on trends in intensive care admissions, interventions, and survival for children with cancer.DesignCohort study using a binational pediatric intensive care registry.SettingAustralia and New Zealand.PatientsPatients younger than 16 years, admitted to an ICU in Australia or New Zealand with an oncology diagnosis between January 1, 2003, and December 31, 2018.InterventionsNone.Measurements And Main ResultsWe examined trends in oncology admissions, ICU interventions, and both crude and risk-adjusted patient-level mortality. Eight thousand four hundred ninety admissions were identified for 5,747 patients, accounting for 5.8% of PICU admissions. Absolute and population-indexed oncology admissions increased from 2003 to 2018, and median length of stay increased from 23.2 hours (interquartile range [IQR], 16.8-62 hr) to 38.8 hours (IQR, 20.9-81.1 hr) ( p < 0.001). Three hundred fifty-seven of 5,747 patients died (6.2%). There was a 45% reduction in risk-adjusted ICU mortality, which reduced from 3.3% (95% CI, 2.1-4.4) in 2003-2004 to 1.8% (95% CI, 1.1-2.5%) in 2017-2018 ( p trend = 0.02). The greatest reduction in mortality seen in hematological cancers and in nonelective admissions. Mechanical ventilation rates were unchanged from 2003 to 2018, while the use of high-flow nasal prong oxygen increased (incidence rate ratio, 2.43; 95% CI, 1.61-3.67 per 2 yr).ConclusionsIn Australian and New Zealand PICUs, pediatric oncology admissions are increasing steadily and such admissions are staying longer, representing a considerable proportion of ICU activity. The mortality of children with cancer who are admitted to ICU is low and falling.Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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