Risk Factors for Readmission Following Febrile Neutropenia in Pediatric Oncology Patients

Area of Science:

• Pediatric Oncology
• Hematology
• Health Services Research

Background:

• Febrile neutropenia is a primary cause for emergency department admissions in pediatric oncology.
• Understanding readmission factors is crucial for improving patient outcomes and healthcare resource allocation.

Purpose of the Study:

• To identify factors associated with 7-day readmission in pediatric oncology inpatients with fever and neutropenia.
• To explore the impact of socioeconomic status and clinical variables on readmission rates.

Main Methods:

• Retrospective analysis of pediatric oncology inpatients (ages 1-21) with malignancy and fever (with or without neutropenia) from 2007-2012.
• Utilized the PHIS+ database to identify 4029 index hospitalizations and evaluate 7-day readmission predictors.
• Statistical analysis included odds ratios to assess the association of various factors with readmission.

Main Results:

• 7.3% (294/4029) of index hospitalizations resulted in readmission within 7 days.
• Increased readmission odds were linked to lower median household income (OR=1.64), acute lymphoblastic leukemia diagnosis (OR=1.37), lack of anaerobic coverage (OR=1.48), and low absolute neutrophil count (<200 cells/μL) at discharge (OR=1.55).
• Readmitted patients experienced longer hospital stays and higher costs during their initial admission.

Conclusions:

• Socioeconomic factors, particularly low income, play a significant role in 7-day readmissions for pediatric oncology patients with febrile neutropenia.
• While absolute neutrophil count is important, addressing socioeconomic disparities is essential for reducing readmission rates.
• There is a concerning trend of increasing hospitalization rates for febrile neutropenia over time.