Clinical practice guidelines for children with cancer presenting with fever to the emergency room

Area of Science:

• Pediatric Oncology
• Emergency Medicine
• Infectious Disease

Background:

• Febrile neutropenia (FN) poses significant risks, including severe infection, septic shock, and mortality, in pediatric oncology patients.
• Clinical practice guidelines were developed to improve outcomes for children with suspected FN in the emergency room (ER).
• This study evaluated adherence to and the impact of these guidelines on pediatric cancer patients presenting with fever.

Purpose of the Study:

• To assess compliance with clinical practice guidelines for pediatric oncology patients with fever in the ER.
• To evaluate the impact of guideline implementation on adverse outcomes, including septic shock and mortality.

Main Methods:

• A retrospective cohort study compared children with cancer presenting with fever before (Jan 2005-Dec 2006) and after (Jan 2007-Dec 2008) guideline implementation.
• Guideline compliance was measured by the time to initial clinical/laboratory assessment and door-to-antibiotic administration.
• Adverse outcomes such as septic shock and death were recorded and compared between groups.

Main Results:

• Post-guideline implementation, 49.4% of patients received timely clinical/laboratory assessment, and 80% received antibiotics within 120 minutes.
• Significant reductions in the prevalence of septic shock (P=0.011) and intensive care unit admission (P=0.016) were observed.
• No infection-associated mortality occurred after the guidelines were implemented.

Conclusions:

• Implementation of clinical practice guidelines for pediatric oncology patients with fever effectively reduces adverse outcomes.
• These guidelines are associated with improved survival rates in children with cancer presenting to the ER with fever.