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Understanding Delayed Presentation to Emergency Care in Pediatric Patients With Neutropenic Fever
Nisa Fraser1, Melissa L Wilson2,3, Randall Y Chan1,4
1Department of Pediatrics, Los Angeles County + University of Southern California.
Insights
Families with a history of neutropenic fever admissions may delay seeking care for subsequent fevers. Previous admissions increased the likelihood of waiting for a second fever episode, highlighting a need for improved patient education and support.
Area of Science:
- Pediatric Hematology-Oncology
- Public Health
- Emergency Medicine
Background:
- Neutropenic fever is a serious complication in pediatric cancer patients, requiring prompt medical attention.
- Delayed presentation for care can lead to severe outcomes.
- Understanding barriers to timely emergency care is crucial for improving patient outcomes.
Purpose of the Study:
- To identify social and logistic factors influencing delayed emergency care for pediatric patients with neutropenic fever.
- To investigate the association between prior admissions for neutropenic fever and delayed presentation for subsequent episodes.
Main Methods:
- Retrospective cohort study of pediatric hematology-oncology patients presenting with neutropenic fever (2015-2020).
- Analysis of social and logistic factors, including distance to medical center, language barriers, and caregiver availability.
- Statistical analysis to determine associations between patient history and delayed presentation.
Main Results:
- Patients with a history of at least two prior admissions for neutropenic fever were significantly more likely to delay seeking care for a subsequent fever (OR 5.00, P=0.04).
- No other social or logistic factors were found to be significantly associated with delayed presentation in this cohort.
- The study highlights a specific patient subgroup at higher risk for delayed care.
Conclusions:
- A history of multiple neutropenic fever admissions is a key predictor of delayed emergency care seeking in pediatric oncology patients.
- Targeted interventions and education for families with a history of neutropenic fever may mitigate delays.
- Further research is needed to explore other potential contributing factors and develop effective strategies to ensure timely access to care.
Abstract:
We investigated social and logistic factors eg, distance from the medical center, language barriers, other children to care for, number of caregivers, etc.) for families to delay seeking immediate emergency care for neutropenic fever in a retrospective cohort study of all pediatric hematology-oncology patients who presented for fever in the setting of neutropenia to our emergency department or clinic from 2015 to 2020. Patients with a history of at least 2 prior admissions for neutropenic fever waited more often for a second fever before presenting versus those without such history (odds ratio 5.00, 95% CI 1.26 to 19.84, P =0.04). No other significant associations were found.
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