Grace E Lee1, Brian T Fisher2, Rui Xiao3, Susan E Coffin4, Kristen Feemster4, Alix E Seif5, Rochelle Bagatell5, Yimei Li6, Yuan-Shung V Huang7, Richard Aplenc8. 1. Division of Infectious Diseases Department of Pediatrics. 2. Division of Infectious Diseases Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania Department of Pediatrics Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia. 3. Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania Department of Pediatrics Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia. 4. Division of Infectious Diseases Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania Department of Pediatrics. 5. Oncology Department of Pediatrics. 6. Oncology Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia. 7. Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania. 8. Oncology Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania Department of Pediatrics Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Abstract
BACKGROUND: Influenza can be severe in patients with underlying malignancy; however, the rate of influenza hospitalizations and attributable mortality in children with cancer is unknown. METHODS: We performed a retrospective cohort study among 10 698 children with new-onset acute lymphoblastic leukemia (ALL) from 41 US children's hospitals between January 1999 and September 2011. Influenza-related hospitalizations were identified using ICD-9 discharge diagnosis codes, excluding hospitalizations during low-prevalence influenza periods. Follow-up was censored at the earliest of 5 events: end of study period, expected end of chemotherapy, last known hospitalization, hematopoietic stem cell transplant, or death. Data were collected on hospitalization characteristics and resource utilization. Hospitalization rates were calculated using season-adjusted person-time. Crude attributable in-hospital mortality was calculated using baseline mortality for noninfluenza hospitalizations during the same period. Subgroup analysis was performed by time from ALL diagnosis and by age category. RESULTS: The rate of influenza-related hospitalizations was 618.3 per 100 000 person-months. Rates were similar by time from ALL diagnosis and across age categories. Overall attributable in-hospital mortality was 1.0% (95% confidence interval [CI], 0.3%-2.3%) and was highest for children <6 months from diagnosis (1.6%; 95% CI, 0.4%-4.5%) and children <2 years of age (6.7%; 95% CI, 1.3%-22.7%). Total length of stay, days of broad-spectrum antibiotic exposure, and duration of intensive care were significantly greater for influenza-related hospitalizations compared with noninfluenza hospitalizations. CONCLUSIONS: The burden of influenza-related hospitalizations in children with ALL is high and associated with significantly increased resource utilization and attributable mortality.
BACKGROUND: Influenza can be severe in patients with underlying malignancy; however, the rate of influenza hospitalizations and attributable mortality in children with cancer is unknown. METHODS: We performed a retrospective cohort study among 10 698 children with new-onset acute lymphoblastic leukemia (ALL) from 41 US children's hospitals between January 1999 and September 2011. Influenza-related hospitalizations were identified using ICD-9 discharge diagnosis codes, excluding hospitalizations during low-prevalence influenza periods. Follow-up was censored at the earliest of 5 events: end of study period, expected end of chemotherapy, last known hospitalization, hematopoietic stem cell transplant, or death. Data were collected on hospitalization characteristics and resource utilization. Hospitalization rates were calculated using season-adjusted person-time. Crude attributable in-hospital mortality was calculated using baseline mortality for noninfluenza hospitalizations during the same period. Subgroup analysis was performed by time from ALL diagnosis and by age category. RESULTS: The rate of influenza-related hospitalizations was 618.3 per 100 000 person-months. Rates were similar by time from ALL diagnosis and across age categories. Overall attributable in-hospital mortality was 1.0% (95% confidence interval [CI], 0.3%-2.3%) and was highest for children <6 months from diagnosis (1.6%; 95% CI, 0.4%-4.5%) and children <2 years of age (6.7%; 95% CI, 1.3%-22.7%). Total length of stay, days of broad-spectrum antibiotic exposure, and duration of intensive care were significantly greater for influenza-related hospitalizations compared with noninfluenza hospitalizations. CONCLUSIONS: The burden of influenza-related hospitalizations in children with ALL is high and associated with significantly increased resource utilization and attributable mortality.
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