{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T14:11:32Z","timestamp":1775743892564,"version":"3.50.1"},"reference-count":43,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2013,11,19]],"date-time":"2013-11-19T00:00:00Z","timestamp":1384819200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2014,5]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Deaths during induction chemotherapy for pediatric acute lymphoblastic leukemia (ALL) account for one\u2010tenth of ALL\u2010associated mortality and half of ALL treatment\u2010related mortality. We sought to ascertain patient\u2010 and hospital\u2010level factors associated with induction mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>We performed a retrospective cohort analysis of 8,516 children ages 0 to &lt;19 years with newly diagnosed ALL admitted to freestanding US children's hospitals from 1999 to 2009 using the Pediatric Health Information System database. Induction mortality risk was modeled accounting for demographics, intensive care unit\u2010level interventions, and socioeconomic status (SES) using Cox regression. The association of ALL induction mortality with hospital\u2010level factors including volume, hospital\u2010wide mortality and payer mix was analyzed with multiple linear regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>ALL induction mortality was 1.12%. Race and patient\u2010level SES factors were not associated with induction mortality. Patients receiving both mechanical ventilation and vasoactive infusions experienced nearly 50% mortality (hazard ratio 122.30, 95% CI 66.56\u2013224.80). Institutions in the highest induction mortality quartile contributed 27% of all patients but nearly half of all deaths (47 of 95). Hospital payer mix was associated with ALL induction mortality after adjustment for other hospital\u2010level factors (<jats:italic>P<\/jats:italic>\u2009=\u20090.046).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The overall risk of induction death is low but substantially increased in patients with cardio\u2010respiratory and other organ failures. Induction mortality varies up to three\u2010fold across hospitals and is correlated with hospital payer mix. Further work is needed to improve induction outcomes in hospitals with higher mortality. These data suggest an induction mortality rate of less than 1% may be an attainable national benchmark. Pediatr Blood Cancer 2014;61:846\u2013852. \u00a9 2013 Wiley Periodicals, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.24855","type":"journal-article","created":{"date-parts":[[2013,11,19]],"date-time":"2013-11-19T11:32:12Z","timestamp":1384860732000},"page":"846-852","source":"Crossref","is-referenced-by-count":24,"title":["Patient and hospital factors associated with induction mortality in acute lymphoblastic leukemia"],"prefix":"10.1002","volume":"61","author":[{"given":"Alix E.","family":"Seif","sequence":"first","affiliation":[{"name":"Division of Oncology The Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian T.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases The Children's Hospital of Philadelphia Philadelphia Pennsylvania"},{"name":"Center for Pediatric Clinical Effectiveness The Children's Hospital of Philadelphia Philadelphia Pennsylvania"},{"name":"Department of Biostatistics and Epidemiology The Perelman School of Medicine The University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yimei","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Oncology The Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kari","family":"Torp","sequence":"additional","affiliation":[{"name":"Division of Oncology The Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas P.","family":"Rheam","sequence":"additional","affiliation":[{"name":"Division of Oncology The Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuan\u2010Shung V.","family":"Huang","sequence":"additional","affiliation":[{"name":"Center for Pediatric Clinical Effectiveness The Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tracey","family":"Harris","sequence":"additional","affiliation":[{"name":"Division of Oncology The Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ami","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Oncology The Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Hall","sequence":"additional","affiliation":[{"name":"Children's Hospital Association Overland Park Kansas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evan S.","family":"Fieldston","sequence":"additional","affiliation":[{"name":"Center for Pediatric Clinical Effectiveness The Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marko","family":"Kavcic","sequence":"additional","affiliation":[{"name":"Division of Oncology The Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marijana","family":"Vujkovic","sequence":"additional","affiliation":[{"name":"Division of Oncology The Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. 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