Trends in mortality among pediatric patients with hemato-oncological diseases admitted to the intensive care unit: A Korean population-based study

Although 40% of pediatric patients with hemato-oncologic diseases require intensive care unit (ICU) admission during their treatment course, nationwide trends in ICU mortality for this population remain poorly defined. We performed a retrospective population-based cohort study using the Korean National Health Insurance Service database from 2009 to 2020. Hospitalizations of patients aged 0–15 years with hemato-oncological diseases were identified and screened for ICU admission. Temporal mortality trends were analyzed using multivariable logistic regression. Subgroup analyses were conducted for admissions that required mechanical ventilation, vasopressors, and hematopoietic cell transplantation. Among 270,862 pediatric hospitalizations, 8,120 (3.0%) required ICU admission. Overall in-hospital mortality rate among ICU admissions was 11.1%, declining from 13.9 to 9.8% ( p < 0.01). Adjusted odds of mortality decreased annually (aOR, 0.91; 95% confidence interval, 0.89–0.93). Admissions requiring mechanical ventilation or vasopressors showed a decline in mortality (both p < 0.01). The proportion of deaths occurring in the ICU remained statistically stable from 43.8% to 50.9% (p for trend = 0.95), while out-of-hospital deaths decreased. ICU mortality among critically ill pediatric hemato-oncological admissions has declined over the past decade, particularly in admissions with respiratory failure and shock. The improvement in mortality may reflect earlier supportive care and advances in the overall management of critically ill patients rather than a shift in the location of death away from the ICU.