Search Results (48,912)

Background: Fragility fractures of the pelvis (FFPs) are increasingly prevalent given ageing populations. Conservative management is often primarily utilised due to its initial minimal displacement and the high risks of surgery in this vulnerable population. However, this can lead to rapid deconditioning, especially with non-weight-bearing protocols. Parathyroid hormone (PTH), as a bone anabolic agent, has the potential to improve clinical and radiological outcomes in FFPs, but the evidence remains limited. Methods: A systematic review and meta-analysis following PRISMA guidelines was undertaken. Database search results were independently screened by two authors, and data were extracted. The primary outcome measure was time to fracture healing as assessed by imaging, with the secondary outcome measure of pain levels (VAS/NRS). Results: There were 1230 articles screened, and 893 unique results identified. Six studies were included in the final analysis. These compared the use of PTH and its analogues with standard care, placebo, or sacroplasty. The findings suggest that PTH may accelerate fracture healing and reduce pain in this patient population, although evidence is limited and at high risk of bias. Conclusions: Treatment with PTH may improve bone healing and visual analogue pain scores, although the evidence is limited. There may be a benefit from adjunctive PTH treatment for patients with FFPs; however, larger methodologically robust studies are required to confirm this. Full article

Background: Unfractionated heparin (UFH) is routinely administered during transcatheter aortic valve replacement (TAVR) to prevent thromboembolic complications. However, there are no clear evidence-based guidelines defining optimal heparin dosing or target activated clotting time (ACT) values. This study aimed to evaluate the association between intraprocedural UFH dosing, ACT values, and peri-procedural stroke risk in the overall population of patients undergoing TAVR, with a prespecified stratified analysis according to body mass index (BMI ≥ 30 vs. <30 kg/m²). Methods: This analysis enrolled consecutive individuals with severe aortic stenosis (AS) who were treated with TAVR using either balloon-expandable or self-expanding valves. The primary outcome was the occurrence of stroke during the periprocedural period in the overall population and according to BMI (<30 vs. ≥30 kg/m²). Secondary endpoints included periprocedural parameters, clinical outcomes (in-hospital and 1-year mortality), and safety outcomes. Subgroup analysis was performed to assess stroke risk according to ACT values. Patients with atrial fibrillation or receiving chronic oral anticoagulation were excluded. Results: A total of 1045 patients underwent TAVR between 2022 and 2024, including 827 with BMI < 30 and 218 with BMI ≥ 30. The study population had a mean age of 82 ± 6 years, and 56% of patients were male. In the overall study population, the mean heparin dose was 47 U/kg and the mean ACT value was 218 s. Patients with lower BMI received higher heparin doses (50 vs. 40 U/kg, p < 0.01) and had higher ACT values (221 vs. 208 s, p < 0.01). Protamine use was low and similar between groups. Periprocedural stroke rates were low overall (1.1%) and comparable between study groups (1.2% vs. 0.9%, p = 0.71). One-year mortality was also similar (3% vs. 4%, p = 0.53), with no significant differences in other safety outcomes. Subgroup analysis by ACT (≤250 vs. >250 s) showed no difference in stroke rates (1% vs. 1.5%, p = 0.60). Conclusions: In this single-center cohort, differences in heparin dosing and ACT values were not associated with differences in peri-procedural stroke or overall procedural outcomes. However, given the low number of stroke events, these findings should be interpreted cautiously. Prospective randomized studies are needed to define optimal anticoagulation strategies during TAVR. Full article

This study presents Care-MOVE, a smartphone-based application designed for continuous, passive, and unobtrusive monitoring of mobility, environmental exposure, and cognitive status in older adults within a telemedicine framework. The system integrates movement-related data collected through smartphone sensors (GPS, activity recognition, and caloric expenditure estimation) with contextual air quality information and standardized neuropsychological assessments, resulting in a comprehensive multimodal dataset (Care-MOVE Dataset). An exploratory proof-of-concept study was conducted on a subsample of 53 participants aged over 65, each monitored continuously for five days, contributing on average more than 30,000 longitudinal records. To investigate whether daily motor behavior can serve as a digital biomarker of cognitive functioning, several Machine Learning and Deep Learning models were evaluated using a Leave-One-User-Out (LOUO) cross-validation strategy. The comparative analysis included traditional classifiers (Logistic Regression, Random Forest, Gradient Boosting, K-Nearest Neighbors, and Support Vector Machines) as well as temporal deep learning architectures (1D CNN, LSTM, GRU, and Transformer). Among all of the evaluated approaches, the Support Vector Machine with RBF kernel achieved the best performance, reaching an accuracy of 98.1%, a balanced accuracy of 0.988, and an F1-score of 0.981, demonstrating robust generalization across unseen subjects. For this reason, the study was designed and presented as an exploratory proof-of-concept rather than a definitive clinical validation. This integrated approach not only enables the collection of detailed and contextualized data but also opens new perspectives for proactive digital healthcare, focused on risk prevention, improving quality of life, and promoting autonomy in elderly patients. Full article

This narrative review integrates longitudinal cohort studies, neuroimaging and biomarker research, and major clinical trials to examine how depression and cognitive decline interact across the dementia continuum. Depression and cognitive impairment frequently co-occur in late life and exhibit substantial clinical and biological overlap. Meta-analytic and large population-based cohort studies consistently show that late-life depression increases the risk of mild cognitive impairment and dementia, with stronger associations observed for vascular dementia than for Alzheimer’s disease. Neurobiological studies implicate cerebrovascular pathology, neuroinflammation, hypothalamic–pituitary–adrenal axis dysregulation, and fronto-subcortical circuit dysfunction as key mechanisms linking depressive symptoms to later cognitive decline. In a subset of older adults, new-onset depression—particularly when accompanied by executive dysfunction, subjective cognitive decline, or high white-matter hyperintensity burden—are associated with an increased likelihood of near-term cognitive decline and dementia, although evidence for a definitive prodromal state remains limited. Depression is also highly prevalent as part of the behavioral and psychological symptoms of dementia, occurring in 30–50% of individuals with Alzheimer’s disease and even higher proportions in dementia with Lewy bodies or frontotemporal dementia. Comorbid depression in dementia accelerates cognitive and functional decline, increases neuropsychiatric burden, and worsens quality of life for patients and caregivers. Therapeutically, antidepressant treatment may confer modest benefits on mood and selected cognitive domains (e.g., processing speed and executive function) in non-demented older adults, whereas in established dementia, antidepressant efficacy is limited. In contrast, cholinesterase inhibitors, memantine, and multimodal non-pharmacological interventions yield small but measurable improvements in depressive or apathy-related symptoms. Emerging disease-modifying therapies for Alzheimer’s disease have demonstrated cognitive benefits, but current trial data provide insufficient evidence regarding effects on depressive symptoms, highlighting an important gap for future research. These findings underscore the need for stage-specific, integrative strategies to address the intertwined trajectories of mood and cognition in aging. Full article

This study aims to establish diagnostic reference levels (DRLs) for common pediatric nuclear medicine (NM) procedures performed within the Dubai Health sector. The established DRLs will serve as a benchmark for pediatric NM practice, supporting standardized healthcare delivery and guiding ongoing quality improvement and internal audit activities. Patient dose survey data were collected from the solo NM center within the Dubai Health sector. The study included common scintigraphy procedures using gamma cameras and the hybrid positron emission tomography with computed tomography (PET/CT) procedures. Scintigraphy procedures include the dynamic and static renal scans, and ocular eye scans. The hybrid PET/CT procedures entail tumor/infection and neuroendocrine scans. Patient demographics, administered activities, CT doses, and study description were recorded. Both weight bands of <5, 5–<15, 15–<30, 30–<50, and 50–<80 kg, and age bands of <1, 1–<5, 5–<10, and 10–<15 years were considered. Statistical analysis was performed to determine the 25th percentile, median and 75th percentile of the dose distribution. The median value was used to establish the DRLs for the Dubai Health sector. The analyses revealed significant variation in the administered activities across the different pediatric NM procedures. The proposed DRLs for various pediatric NM procedures for the weight band 15–<30 kg are as follows: renal dynamic 98.4 MBq, renal static 96.2 MBq, ocular eyes 18.5 MBq, tumor/infection 155 MBq, and neuroendocrine 80 MBq. This work provides the first pediatric NM DRLs for the Dubai Health sector, offering a key reference for developing the local DRLs for the Emirate of Dubai. The findings indicate that achieving meaningful dose optimization will require systematic revision of existing imaging protocols, with targeted parameter adjustments informed by continuous dose monitoring and benchmarking to enhance patient safety and overall diagnostic quality. Full article

Background: Osteoporosis is a prevalent metabolic bone disorder characterized by reduced bone mineral density (BMD) and increased fracture risk, particularly among older adults. While individual medications have been implicated in bone loss, the cumulative impact of polypharmacy on skeletal health remains underexplored. Methods: This cross-sectional study included 1155 geriatric inpatients undergoing routine bone mineral density assessment. Medication use, demographic characteristics, and clinical variables were extracted from electronic medical records. BMD at the lumbar spine (L1–L4) and total hip was measured using dual-energy X-ray absorptiometry (DXA). Unadjusted analyses and multivariable linear regression models were used to examine associations between medication use, polypharmacy (defined as the use of ≥5 medications), and BMD, adjusting for age, sex, body mass index, and relevant clinical covariates. Results: The mean age of the study population was 85.0 ± 7.1 years, and 80.1% were female. Polypharmacy was present in 64.5% of patients. In medication-specific analyses, thyroid hormone use was associated with lower lumbar spine BMD (p = 0.032), and concomitant use of diuretics and proton pump inhibitors was associated with lower hip BMD (p = 0.049). Steroid use showed a marginally non-significant correlation with reduced BMD (p = 0.057). Polypharmacy was associated with lower lumbar spine BMD (p = 0.022), whereas no significant association was observed with hip BMD. Increasing age was consistently associated with lower BMD across skeletal sites (p < 0.001). Conclusions: In this geriatric inpatient cohort, polypharmacy and selected medication classes were associated with lower bone mineral density, particularly at the lumbar spine. Given the cross-sectional design, these findings reflect associations rather than causal relationships and may partly capture underlying multimorbidity and clinical complexity. Consideration of medication burden may be relevant when evaluating bone health in older adults. Polypharmacy is increasingly common in older adults and may contribute to bone fragility. In this cohort of 1155 geriatric inpatients, multiple medications and certain drug classes were associated with lower bone mineral density, particularly in the spine. These findings suggest that medication burden should be considered when evaluating osteoporosis risk in aging populations. Full article

Objective: Solid pseudopapillary neoplasms (SPN) and pancreatoblastoma (PB) have a low overall incidence but represent the most common pancreatic tumors in childhood. Currently, there is a lack of systematic descriptions of contrast-enhanced ultrasound (CEUS) features for these two tumors in pediatric populations. This study aims to retrospectively analyze and compare the CEUS characteristics of SPN and PB to explore key imaging differentiation points. Methods: This retrospective study collected data on 22 patients with solid pseudopapillary neoplasms and pancreatic blastomas of the pancreas who were pathologically diagnosed at a children’s hospital between September 2019 and May 2025. The ultrasound contrast-enhanced imaging findings for both tumor types were summarized and analyzed. Two physicians with different levels of experience performed qualitative analysis of the contrast-enhanced images, while quantitative analysis was conducted using time–intensity curve (TIC) analysis software. Results: This study included a total of 22 pediatric patients (19 with SPN and 3 with PB). Significant differences existed between the two groups in age (13.51 years vs. 2.94 years) and Ki-67 index (5.00% vs. 30.00%). Qualitative analysis revealed high heterogeneity in SPN enhancement patterns, with capsular enhancement with cystic components being the most common (42.11%). All PBs (100%) consistently demonstrated the “disorganized nourishing vessels” sign. Quantitative analysis revealed that PBs exhibited numerically higher IMAX values (179.84% vs. 60.56%) and faster WoR trends (773.88 vs. 275.38). Inter-observer consistency analysis supported measurement reliability (key parameters ICC > 0.80). Conclusions: This preliminary study indicates differences in CEUS characteristics between pediatric SPN and PB; PB tends to exhibit rapid, high enhancement with chaotic feeding vessels and rapid washout, whereas SPN more commonly presents with moderate, slow enhancement patterns, often accompanied by features associated with cystic components. These findings provide new hemodynamic clues for their imaging differentiation. Given the extremely small sample size of PB cases, the above conclusions should be regarded as preliminary hypotheses awaiting validation in future large-scale studies. Full article

Objective: Heart failure (HF) remains a major global health challenge. We evaluated ten-year trends in clinical profiles, diagnostic/therapeutic management, and outcomes in patients hospitalized for de novo acute heart failure (AHF). Methods: We compared two multicenter cohorts of patients admitted to Internal Medicine departments in Spain for a first episode of HF (excluding acutely decompensated chronic HF): a retrospective cohort (CH-2005; n = 600) and a prospective cohort (CH-2015; n = 180). We assessed clinical characteristics, adherence to guideline-recommended diagnostic testing, discharge treatment, and 12-month outcomes (HF readmissions and all-cause mortality). Results: The patients in CH-2015 showed a markedly higher comorbidity burden (Charlson Comorbidity Index > 2: 90.0% vs. 12.8%, p < 0.001) and higher chronic kidney disease prevalence (17.8% vs. 11.8%, p = 0.01), while mean age was similar (75.0 vs. 73.6 years, p = 0.16). Diagnostic adherence improved with higher echocardiography use (92.2% vs. 66.5%, p < 0.001). Discharge beta-blocker prescriptions increased (50.6% vs. 31.3%, p < 0.001). HF readmissions were higher in CH-2015 at 1 month (35.6% vs. 7.3%, p < 0.001) and 12 months (49.4% vs. 21.2%, p < 0.001). One-year mortality was higher in CH-2015 (22.5% vs. 16.3%, p = 0.07). In the multivariable analyses, the between-cohort difference in mortality was not significant, whereas the higher readmission risk in CH-2015 persisted. Conclusions: Over a decade, de novo AHF admissions shifted toward a more complex, multimorbid phenotype. Despite improved diagnostic testing and small advances in evidence-based therapy, the readmission burden increased, highlighting the need for integrated, post-discharge management strategies in older multimorbid populations. Full article

Objective: The primary objective of this study is to investigate the prevalence of unexpected findings requiring treatment after routine histological examinations following tonsillectomy, tonsillotomy, adenotomy, or conchotomy (TTAC) in a retrospective study and to discuss whether routine histological examination is useful in patients without clearly defined risk factors or whether it would be better to reduce unnecessary costs and resource utilisation. Materials and methods: The present retrospective study encompasses 5709 patients who underwent routine histological examinations following TTAC and were treated as inpatients at the University Medical Center Freiburg, Department of Otolaryngology, Head and Neck Surgery, between 2011 and 2021. The data was collected based on patient characteristics, including date of birth, gender, age of patients at the time of surgery, date of surgery, indication for surgery, tissue examined, and histological result. Results: Of a total of 6687 patients who underwent TTAC, 5709 with routine histological examinations were included in the analysis, of whom only four showed abnormal findings, corresponding to an overall prevalence of 0.07%. Three of these four patients were adults. These included two cases of granulomatous inflammation, one instance of Burkitt lymphoma, and one instance of chronic lymphocytic leukaemia/small cell B-lymphoma. Following the exclusion of tuberculosis and sarcoidosis, and the lymphoma board’s decision to adopt a watch-and-wait approach in the case of chronic lymphocytic leukaemia/small cell B-cell lymphoma, only n = 1/0.0175% of patients were found to require treatment. Conclusions: The study demonstrated that only four abnormal histological findings occurred in 5709 inpatient TTACs, of which only one, namely Burkitt lymphoma, ultimately required treatment. Consequently, it can be concluded that routine histological examinations following TTAC are not beneficial in patients without clearly defined risk factors, such as blood in the saliva, history of smoking or alcohol consumption, unexplained pain, previous cancer, mucosal changes, or tissue asymmetries. However, in instances where clinical or anamnestic suspicion of malignancy is present, a histological examination should be conducted. Full article

Background. Cor triatriatum dexter (CTD) is a rare congenital heart defect where a membrane divides the right atrium into two chambers, resulting from the incomplete regression of the right valve of the sinus venosus. Due to its rarity, only individual case reports and a limited number of case series have been published to date. This study constitutes the most extensive comprehensive review conducted in this area. Eight factors were evaluated: age at diagnosis, sex, clinical presentation, electrocardiographic findings, imaging (ultrasound, CT, or MRI), associated cardiac anomalies, and patient outcomes. Methods. The electronic databases PubMed and Scopus were searched from their inception until 30 October 2025. Only case reports and case series were considered for inclusion. Studies involving foetuses, autopsies, and animals were excluded. The collected data were primarily presented as percentages. Results. One hundred fourteen studies were found encompassing 124 patients. The mean age at diagnosis was 33.3 ± 9.4 years The most common clinical presentations were dyspnoea (44.3%) and cyanosis (29.5%). The most commonly encountered ECG changes were supraventricular tachycardia/atrial flutter/atrial fibrillation (33.3%) and right bundle branch block (22.6%). On chest X-ray, cardiomegaly was noted in 46.5%. CTD was suspected or diagnosed by echocardiography in 95.2% of cases. The diagnosis was confirmed by CT and/or MRI in 34.1% of cases. A concomitant congenital heart defect was found in 67.7%, especially in the form of all kinds of atrial septal defect (38.1%) and of right valvular and right ventricular involvement (20.1%). An outcome was reported in 97/124. Surgical correction was the treatment of choice in 51.6%. Since 1991, a percutaneous approach has been employed in selected cases (5.1%). Conservative management was the treatment of choice in 43.3%. The mortality rate was 8.2%. Discussion. The principal limitation of this systematic review lies in its reliance solely on case reports and small case series, reflecting the absence of large-scale studies on CTD. Nonetheless, it constitutes the most comprehensive analysis available to date. Full article

Background/Objectives: Dalbavancin is approved for pediatric acute bacterial skin and skin structure infections (ABSSSIs), yet real-world practice frequently necessitates off-label use for deep-seated infections requiring prolonged suppression. While adult data support therapeutic drug monitoring (TDM)-guided maintenance, the pediatric evidence for repeated-dose pharmacokinetics (PK) is limited. We evaluated the efficacy, safety, multi-dose PK, and pharmacoeconomic impact of dalbavancin in a complex pediatric cohort. Methods: A retrospective study (2023–2025) of enrolled patients < 18 years treated with dalbavancin. A subgroup receiving ≥3 doses underwent PK analysis to assess concentration decay against conservative efficacy targets (4 and 8 mg/L). A pharmacoeconomic analysis compared resource utilization against the standard of care. Results: Sixteen patients (median age 12) were included, primarily treated for Staphylococcus aureus (S. aureus) osteoarticular infections (75%), and frequently device-associated (66.7%). Clinical success was 93.8% (15/16) with no adverse events. A PK analysis (n = 9; 78 samples) ruled out dangerous accumulation but revealed a significant concentration drop at week 4 (mean 6.06 mg/L; p = 0.005). Logistic regression identified the time since the previous dose as the sole predictor of sub-therapeutic levels, with >50% of the patients dropping below 8 mg/L by the fourth week. An analysis showed median net savings of EUR 3215.84 per patient (p = 0.004). Conclusions: Dalbavancin is effective and cost-saving for complex pediatric infections. However, due to distinct pediatric PK, dosing regimens extrapolated from adults may result in sub-therapeutic concentrations by week 4. We recommend TDM around week 3 to tailor dosing or limiting maintenance intervals to a maximum of 4 weeks. Full article

Background: Severe lower urinary tract dysfunction (LUTD) in neurologically and anatomically normal children is uncommon and frequently underdiagnosed. When severe, functional voiding disorders may closely mimic obstructive or reflux pathology, leading to diagnostic errors, unnecessary invasive procedures, and potential risk to the upper urinary tract. Case presentation: We present three pediatric cases (aged 3–10 years) referred for recurrent febrile urinary tract infections, incontinence, or acute urinary retention in the absence of neurological or structural abnormalities. Urodynamic evaluation identified three distinct severe functional phenotypes: detrusor overactivity with reduced bladder capacity, poor compliance with detrusor–sphincter dyssynergia and secondary high-grade vesicoureteral reflux (Hinman syndrome), and detrusor underactivity with significant post-void residual volumes. All patients demonstrated marked bladder wall remodeling on cystoscopy, including trabeculation and pseudopolypoid mucosal changes. Case discussion: Despite similar clinical severity, the cases illustrated substantial functional heterogeneity and differing risks of upper urinary tract involvement. Urodynamic phenotyping proved central to diagnosis, differentiation from structural disease, and treatment planning. Multimodal conservative management—including urotherapy, pelvic floor biofeedback, targeted pharmacologic therapy, and, when indicated, clean intermittent catheterization or antibiotic prophylaxis—led to resolution of recurrent infections and meaningful improvement in bladder function during medium-term follow-up, although symptom recurrence occurred in one patient after treatment withdrawal. Conclusions: These cases highlight the heterogeneity and potential reversibility of severe functional LUTD in otherwise healthy children. Early functional recognition based on urodynamic assessment is essential to avoid misdiagnosis, prevent unnecessary surgical intervention, and protect renal function. Conservative, function-oriented management remains the cornerstone of effective treatment. The findings are discussed in the context of the existing literature on severe non-neurogenic LUTD and Hinman syndrome. Full article

Background/Objectives: Prior studies suggest that rates of Helicobacter pylori colonization are higher among Hispanic immigrants compared to U.S.-born Hispanics. It is unknown whether differences in H. pylori colonization rates among Hispanics are related to immigration status or to cultural factors such as diet. Methods: This was a survey study, conducted among self-identified Hispanics who had an endoscopy for symptoms of gastroesophageal reflux disease (GERD). Qualifying patients completed a telephone survey which included questions about immigration status and the 12-item Short Acculturation Scale for Hispanics (SASH), a validated instrument which measures cultural factors such as language preference and diet. We examined the relationship between SASH factors and H. pylori status, classified based on endoscopic biopsy results. Results: We called 400 patients and 186 completed the survey. Median age was 65 (interquartile range 21 to 82) and 81% were female. Thirty of 186 (16%) respondents were born in the U.S. while 156/186 (84%) were immigrants, primarily from the Dominican Republic. Among immigrants, 69% had immigrated before 1990. Rates of H. pylori were 8/30 (27%) among U.S. born Hispanics compared to 51/156 (33%) among Hispanic immigrants (p = 0.67). Rates of H. pylori were 51/147 (35%) among those with a mostly Latino diet vs. 8/39 (21%) among those with a U.S or mixed diet (p = 0.05). In a multivariable model predicting H. pylori status, a mostly Latino diet was the only cultural predictor which approached statistical significance (p = 0.05) (aOR 2.61, 95% CI 0.94–7.20). Conclusions: Rates of H. pylori colonization were modestly higher among Hispanic immigrants compared to U.S.-born Hispanics. A novel preliminary finding was that higher rates of H. pylori colonization were observed among those who ate a predominantly Latino diet. Full article

Post-translational modifications of human serum albumin (HSA) have been described in patients with liver disease. This prospective cohort study aimed to characterize HSA microheterogeneity in hospitalized patients with alcohol-associated hepatitis (AH) and investigate its clinical relevance. We analyzed HSA isoforms by mass spectrometry in 49 patients with AH (at admission and day 14) and 20 healthy controls. Survival at 30, 90, and 365 days was assessed. Differences in HSA isoform abundance were compared between controls and AH patients, as well as between 90-day survivors and non-survivors. AH patients (69% male, median age 53 years) exhibited a significantly different HSA form profile compared to controls, with a lower amount of native HSA and higher oxidized forms. Native HSA negatively correlated with total HSA concentration (R = −0.47, p < 0.001). The relative amount of native HSA increased non-significantly from admission to day 14, but its estimated concentration increased significantly (8.8 vs. 12.0 g/L, p = 0.005). There were no significant differences in HSA forms between 90-day survivors and non-survivors at admission or day 14. Patients with AH exhibit extensive post-translational modifications of HSA compared to healthy individuals. While HSA forms changed during early hospitalization, they did not significantly correlate with short-term mortality in this cohort. Full article

Background and Objectives: Little is known about the final week of life for inpatient pediatric oncology patients. The purpose of this study was to describe inpatient pediatric oncology deaths. Methods: Retrospective chart review of all patients who died in a large pediatric cancer center between 2007 and 2017. Demographic, diagnostic, and proximate cause of death information was extracted. Intensive care unit (ICU) admissions, chemotherapy receipt, medical interventions, and cardiopulmonary resuscitation (CPR) events one week, 48 h, and 24 h prior to death were obtained. Analysis included descriptive and statistical correlations. Results: 344 decedent pediatric oncology patients were included. Half of the patients died in the ICU (51%). The average age was 11.3 years (range 0.13–27.7 years). Most had ongoing evidence of disease (86%) with 20% receiving cure-directed chemotherapy during their final week. Receiving cure-directed chemotherapy was not associated with age, race, ethnicity, or diagnosis but was associated with a significantly increased likelihood of receiving CPR on the last day of life (p = 0.011). The majority (84%) of children did not receive CPR on their final day of life. Receipt of CPR was not associated with race/ethnicity. CPR was associated with younger age (p = 0.006), hematologic malignancies (p = 0.037), and ICU location (p < 0.001). Most patients were not on dialysis (84%), pressors (72%), or ventilated (60%) during the final 24 h of life. Compassionate extubation occurred in <6% of deaths. Conclusions: Most deaths in a pediatric cancer center occur in children with active disease. Continuation of cure-directed chemotherapy, age, diagnosis, and location of death has potential to influence end-of-life inpatient care. Full article