Assembly of a cohort of children treated for acute myeloid leukemia at free‐standing children's hospitals in the United States using an administrative database

Kavčič, Marko; Fisher, Brian T.; Torp, Kari; Li, Yimei; Huang, Yuan‐Shung; Seif, Alix E.; Vujkovic, Marijana; Aplenc, Richard

doi:10.1002/pbc.24402

Cited by 34 publications

(54 citation statements)

References 14 publications

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“…Despite the strengths of PHIS data and the use of chemotherapy billing data in cohort establishment (28), this study has limitations. The definition if ICU care was based on resource utilization codes rather than physical patient location.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, the billing data for chemotherapy agents commonly used for the treatment of AML were manually reviewed for each remaining patient. Those patients who did not receive a chemotherapy regimen consistent with AML induction therapy were excluded (28). Patients entered the cohort on the day of their first hospitalization containing induction chemotherapy for AML (index admission).…”

Section: Methodsmentioning

confidence: 99%

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Outcome of Pediatric Acute Myeloid Leukemia Patients Receiving Intensive Care in the United States

Maude

Fitzgerald

Fisher

et al. 2014

Pediatric Critical Care Medicine

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Objective Children with acute myeloid leukemia are at risk for sepsis and organ failure. Outcomes associated with intensive care support have not been studied in a large pediatric acute myeloid leukemia population. Our objective was to determine hospital mortality of pediatric acute myeloid leukemia patients requiring intensive care. Design Retrospective cohort study of children hospitalized between 1999 and 2010. Use of intensive care was defined by utilization of specific procedures and resources. The primary endpoint was hospital mortality. Setting Forty-three children’s hospitals contributing data to the Pediatric Health Information System database. Patients Patients who are newly diagnosed with acute myeloid leukemia and who are 28 days through 18 years old (n = 1, 673) hospitalized any time from initial diagnosis through 9 months following diagnosis or until stem cell transplant. A reference cohort of all nononcology pediatric admissions using the same intensive care resources in the same time period (n = 242,192 admissions) was also studied. Interventions None. Measurements and Main Results One-third of pediatric patients with acute myeloid leukemia (553 of 1,673) required intensive care during a hospitalization within 9 months of diagnosis. Among intensive care admissions, mortality was higher in the acute myeloid leukemia cohort compared with the nononcology cohort (18.6% vs 6.5%; odds ratio, 3.23; 95% CI, 2.64–3.94). However, when sepsis was present, mortality was not significantly different between cohorts (21.9% vs 19.5%; odds ratio, 1.17; 95% CI, 0.89–1.53). Mortality was consistently higher for each type of organ failure in the acute myeloid leukemia cohort versus the nononcology cohort; however, mortality did not exceed 40% unless there were four or more organ failures in the admission. Mortality for admissions requiring intensive care decreased over time for both cohorts (23.7% in 1999–2003 vs 16.4% in 2004–2010 in the acute myeloid leukemia cohort, p = 0.0367; and 7.5% in 1999–2003 vs 6.5% in 2004–2010 in the nononcology cohort, p < 0.0001). Conclusions Pediatric patients with acute myeloid leukemia frequently required intensive care resources, with mortality rates substantially lower than previously reported. Mortality also decreased over the time studied. Pediatric acute myeloid leukemia patients with sepsis who required intensive care had a mortality comparable to children without oncologic diagnoses; however, overall mortality and mortality for each category of organ failure studied was higher for the acute myeloid leukemia cohort compared with the nononcology cohort.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Outcome of Pediatric Acute Myeloid Leukemia Patients Receiving Intensive Care in the United States

Maude

Fitzgerald

Fisher

et al. 2014

Pediatric Critical Care Medicine

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“…14,15 The hospitals included in this study were primarily urban, academic hospital centers affiliated with major medical centers. The PHIS hospital size varies from 100 to 500 beds.…”

Section: Methodsmentioning

confidence: 99%

“…Patients with ALL or AML were identified with a combination of International Classification of Diseases, Ninth Revision , diagnosis codes and a manual review of induction chemotherapy exposures, as previously validated. 14,15 …”

Section: Methodsmentioning

confidence: 99%

Low rates of pregnancy screening in adolescents before teratogenic exposures in a national sample of children's hospitals

Rao

Getz

et al. 2016

Cancer

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BACKGROUND Adolescents with cancer engage in sexual behaviors and are exposed to teratogenic chemotherapy. There are no data regarding pregnancy screening patterns for adolescents before chemotherapy exposure. METHODS A cross-sectional study of leukemia and emergency room (ER) admissions in the Pediatric Health Information System from 1999 to 2011 was conducted. Females who were 10 to 18 years old and 1) had newly diagnosed acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) or 2) had ER visits with computed tomography (CT) of the abdomen/pelvis were included. The exposure was a hospital visit with either chemotherapy or an abdominal/pelvic CT scan. The main outcome was a pregnancy test billed on the same day or before the teratogenic exposure within the same index admission. Log-binomial regressions were used to compute prevalence ratios and 95% confidence intervals comparing pregnancy screening in the leukemia and ER cohorts. RESULTS A total of 35,650 admissions were identified. The proportion of visits with an appropriately timed pregnancy test was 35%, 64%, and 58% in the ALL (n5889), AML (n = 127), and ER cohorts (n = 34,634), respectively. Patients with ALL were significantly less likely to have a pregnancy test than the ER cohort (adjusted prevalence ratio, 0.71; 95% confidence interval, 0.65–0.78), but there was no significant difference between the AML and ER cohorts (adjusted prevalence ratio, 1.12; 95% confidence interval, 0.99–1.27). There was substantial hospital-level variation in pregnancy screening patterns. CONCLUSIONS Adolescents with acute leukemia and ER visits have low rates of pregnancy screening before teratogenic exposures. Standardized practice guidelines for pregnancy screening among adolescents may improve screening rates.

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“…To overcome this challenge, Desai et al developed an algorithm (using ICD-9 codes, exclusion criteria, and manual review of chemotherapy billing data) to assemble a high-risk neuroblastoma cohort at a single institution [21]. Similarly, Kavcic et al [22] confirmed an algorithm to identify children using PHIS with acute myeloid leukemia (AML) based on ICD-9 diagnosis and manual review of chemotherapy.…”

Section: Other Administrative Databasesmentioning

confidence: 99%

Use of patient registries and administrative datasets for the study of pediatric cancer

Rice

Englum

Gulack

et al. 2015

Pediatric Blood & Cancer

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Analysis of data from large administrative databases and patient registries is increasingly being used to study childhood cancer care, although the value of these data sources remains unclear to many clinicians. Interpretation of large databases requires a thorough understanding of how the dataset was designed, how data were collected, and how to assess data quality. This review will detail the role of administrative databases and registry databases for the study of childhood cancer, tools to maximize information from these datasets, and recommendations to improve the use of these databases for the study of pediatric oncology.

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Assembly of a cohort of children treated for acute myeloid leukemia at free‐standing children's hospitals in the United States using an administrative database

Cited by 34 publications

References 14 publications

Outcome of Pediatric Acute Myeloid Leukemia Patients Receiving Intensive Care in the United States

Outcome of Pediatric Acute Myeloid Leukemia Patients Receiving Intensive Care in the United States

Low rates of pregnancy screening in adolescents before teratogenic exposures in a national sample of children's hospitals

Use of patient registries and administrative datasets for the study of pediatric cancer

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