Pediatric Oncology and Bone Marrow Transplant ICU Patients in Children’s and General Hospitals

Pediatric oncology and hematopoietic stem cell (HCT) care in the US is increasingly provided at children’s hospitals (CH), but many children still receive care at general hospitals (GH). Little is known about the characteristics of pediatric oncology and HCT patients treated in intensive care units (ICUs) at these institutions, or how outcomes differ for patients treated in CH and GH. Using data from ICU admissions of pediatric oncology and HCT patients in the U.S. during 2001-2019, we examined possible differences between patients treated at CH versus GH with regard to characteristics that could bear on illness outcomes. Specifically, we used the Healthcare Cost and Utilization Project’s State Inpatient Databases from a total of 21 U.S. states for 2001, 2004, 2010, 2016, and 2019. We used ICD-9 and 10 codes to identify diagnoses, chronic comorbidities and American Hospital Association linkage files to identify hospital type. Also, we evaluated changes over time in the proportions of American pediatric ICU patients seen at CH versus GH. During the five years for which data were examined, there were 9,306 oncologic admissions and 1,497 HCT admissions to CH ICUs; over the same time period, there were 2,038 oncologic admissions and 238 HCT admissions to GH ICUs. There was little difference in the demographic characteristics of patients seen in the two ICU locations. The presence of chronic co-morbidities was somewhat greater in CH than GH patients (61.7% vs. 50.0%). The results of this study suggest that comparisons of illness outcomes for pediatric ICU patients with malignancies or HCT between CH and GH will not be appreciably confounded by differences in demographic characteristics. Subsequent studies that are able to assess illness severity at the time of admission will be needed to gauge the potential for confounding from this source.