Sebastian Proano Coello, MD
Nicklaus Childrens Hospital
Miami, Florida
Disclosure information not submitted.
Manette Ness-Cochinwala, MD
Pediatric Critical Care Attending
Rutgers Robert Wood Johnson
Miami, Florida
Disclosure information not submitted.
Balagangadhar Totapally, MBBS, MD, DCH, MRCP, FAAP, FCCP, FCCM
Chief, Division of Critical Care Medicine. Program Director, Critical Care Fellowship Program
Nicklaus Children's Hospital, United States
Disclosure information not submitted.
Title: Pediatric Anterior Mediastinal Masses: A National Database Study
Introduction: Pediatric Anterior Mediastinal Masses (AMM) represent a significant challenge as they can cause airway obstruction and hemodynamic instability. This study aims to assess the prevalence and outcomes of pediatric AMM in the U.S.
Methods: A retrospective analysis of the HCUP 2016 Kids Inpatient Database was performed. The database was filtered for ICD-10 codes for tumors of the anterior mediastinum. Elective admissions were excluded to control for repeated admissions. Neonates (< 30 days old) were also excluded. Sample weighting was employed to produce national estimates and complex sample analysis was used where appropriate. Chi-square tests were performed using SPSS.
Results: Of the 1,781,033 weighted discharges, 428 (95% C.I. 326 - 530, 2.4/10,000 hospital discharges) had a diagnosis of AMM. The mortality rate was 3.8% (n=16, C.I. 2.2 - 6.5). There was no significant difference in race/ethnicity between AMM and the general population. Patients 12 years and older accounted for 66.5% (C.I. 59 - 73.3%) of AMMs discharges.
Of the AMMs, lymphoma accounted for 26.4% of cases (C.I. 19.5 -34.8), thymic tumors (excluding lymphomas) for 1.2% (C.I. 0.5 -3.3), and other types of tumors for 45.4% of cases (C.I. 37.6 - 53.5). Malignant tumors accounted for 92.6% cases (C.I. 88.5 - 95.3).
The most common complications associated with AMM diagnosis were pleural effusion (19.3%), pericardial effusion (6.8%), deep venous thrombosis (5.9%), tumor lysis syndrome (5.5%), and superior vena cava syndrome (5.5%). Lymph node biopsy was documented in 2.5% of cases. Mechanical ventilation was required in 4.3% of cases and no patients required ECMO. On univariate analysis, the need for intubation/mechanical ventilation (OR 16.9, 95% C.I. 4.1 - 70.2) and the presence of pleural effusions (OR 3.6; C.I. 1.1 - 11.4) were associated with increased risk of mortality. Malignant pleural effusions specifically had a higher association with mortality (OR 6.4, C.I. 1.4 - 29.8).
Conclusions: The majority of AMM in pediatrics are malignant, and adolescents are the most affected age group. Our descriptive study identifies these patients as a potential high-risk cohort that may require advanced airway management and intensive medical care. Intubation and pleural effusions are associated with an increased risk of mortality.