LETTER TO THE EDITOR: SETTING GOALS OR SHIFTING GOALPOSTS: ROLE OF FRAILTY FOR CRITICAL CARE DECISIONS DURING COVID-19

Frailty is characterized by a loss of physiological reserves leading to increased susceptibility to adverse outcomes with stressor events (1). With healthcare resources worldwide overstretched by the unprecedented COVID-19 pandemic, there is intense interest in reliable assessment tools to inform patient prioritization for scarce intensive care resource. Not surprisingly, frailty tools have been thrust into the spotlight as the panacea to age-based criteria for critical care triage decisions. However, detractors worry that rigid and indiscriminate application of frailty tools may ironically exacerbate the deprioritising of older adults and other vulnerable populations. Herein, we describe the 3F approach to guide thinking about the role of frailty in critical care decisions for older adults during the COVID-19 pandemic.

Pediatric Intensive Care Resource Utilization Following Hematopoietic Cell Transplantation in Children with Acute Leukemia

Pediatric Intensive Care Resource Utilization following Hematopoietic Cell Transplantation in Children with Acute Leukemia Baldes C1, Wetzel M3, McCraken C3, Saber W4, Arnold SD2. Introduction: Hematopoietic cell transplantation (HCT) is one of the mainstays of treatment of acute leukemia in children. While previous studies have calculated the overall healthcare resource utilization following this treatment, to date there is limited analysis regarding intensive care resource utilization specifically. The goal of this research is to investigate the costs associated with and potential patient drivers of intensive care resource utilization following hematopoietic cell transplantation in children with acute leukemia. Methods: Retrospective study of U.S. patients aged 1-20 years who received HCT for acute lymphoblastic leukemia (ALL) or acute myelogenous leukemia (AML) from 2004-2011 using data merged from the Pediatric Health Information System (PHIS) and the Center for International Blood and Marrow Transplant Research (CIBMTR). We investigated the primary outcome of total intensive care unit (ICU) cost and total ICU cost per day survived from initial HCT through 100-day post-transplant as well as through two-year follow-up using paired comparisons with Wilcoxon rank sums tests for differences in costs between groups. Results: We identified 202 patients with at least one ICU admission in the first 100 days and 292 in the two years following HCT. At day 100, ICU cost per day survived and total ICU cost were lower for secondary AML (P=0.019; P=0.022, respectively) when compared to AML but no significant difference was identified for ALL patients (P=0.186 ;P=0.064, respectively) compared to AML. Cytomegalovirus (CMV) seropositivity compared to seronegativity (P=0.027; P=0.027, respectively) had higher ICU cost per day survived and total ICU cost at day 100 and at 2-years post-HCT (P=0.026; P=0.045, respectively) (Table 1). At 2-years post-HCT, disease status also showed a statistically significant relationship between ICU cost per day survived and total ICU cost for intermediate disease status at transplant (p<0.001; P=0.018) and ICU cost per day survived for advanced disease (P=0.042) compared to early disease status. Females transplant recipients (P=0.042) and, when compared to matched unrelated donor, unrelated cord blood transplants (P=0.029) also had significantly higher ICU cost per day but not total ICU cost (Table 2). Conclusion: Among patients with at least one ICU visit, patients who are CMV negative generate less ICU costs and costs per day survived at both time intervals. While disease status, donor type, and gender become significant at two-years post HCT. This analysis may help identify patient specific risks that could be mitigated by surveillance or supportive care measures. Ultimately, further investigation of pre-transplant diagnosis, donor type, gender, and disease status at transplant is needed to better determine specific factors influencing these cost outcomes. 1. Department of Pediatrics, Emory University, Atlanta, Georgia. 2. Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia. 3. Pediatric Biostatistics Core, Emory University, Atlanta, Georgia. 4. CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI. Disclosures No relevant conflicts of interest to declare.