Abstract

OBJECTIVE: To evaluate the prevalence of torsades de pointes and to identify risk factors associated with QTc prolongation of =500milliseconds in hospitalized pediatric oncology patients. A QTc prolongation of =500milliseconds is associated with higher mortality in hospitalized adults but has not been demonstrated in pediatrics.STUDY DESIGN: A single-center, retrospective review of all hospitalized oncology patients =21years of age was performed from 2014 to 2016. Patients with long/short QT syndrome or a QRS interval of =120ms were excluded. Rapid response events were reviewed to determine the prevalence of torsades. In patients with ECGs for review, data were compared between patients with a QTc of <500 and=500ms via logistic regression.RESULTS: There were 1934 hospitalized patients included. Rapid response events occurred in 90 patients (4.7%) with 2 torsades events (0.1%). There were 1412 electrocardiograms performed in 287 unique patients (10.6±6.3years of age; 43% female). The mean QTc was 448±31ms; 25 patients (8.7%) had =1 ECG with a QTc of =500ms. The prevalence of torsades was greater in patients with a QTc of =500ms (8% vs 0%; P<.01). In multivariate analysis, factors associated with a QTc of =500ms included female sex, (OR 2.95) and =2 QT-prolonging medications (OR, 2.95).CONCLUSIONS: The prevalence of torsades in hospitalized pediatric oncology patients was low (0.1%), although the risk was significantly greater in patients with a QTc of =500ms. Routine monitoring of electrocardiograms and electrolytes is essential in patients with risk factors predisposing to QTc prolongation.

View details for DOI 10.1016/j.jpeds.2019.10.018

View details for PubMedID 31761428