Risk Stratification in Pediatric Patients with Cancer and Febrile Neutropenia
Georgina Elizabeth Féliz Bermúdez, Astrid Anaid Hernández Soto, Michel Mata Castañeda, Jocelyn Rivera-Mijares, Daniel-Alejandro Lopez-AguileraAbstract
Background and Aims
Risk stratification in patients with febrile neutropenia (FN) is an approach recommended in updated guidelines to optimize resources, increase the quality of life in patients, and avoid complications associated with hospitalizations. Recommendations include selecting an appropriate scale to classify all FN patients into low—and high-risk categories. The present study aims: to describe the characteristics of FN pediatric patients admitted, stratify the risk of FN, and correlate high—and low-risk groups with their clinical outcomes.
Methods
This is an analytic retrospective study. Non-identifiable data will be collected from clinical records of patients aged 0 to 18 who had an FN event from January 2016 to December 2018 and classified with Santolaya’s stratification scale. Data will be analyzed using descriptive statistics for the High- and Low-Risk FN groups and their outcomes.
Results
We found 81 febrile neutropenic patients, with 182 admissions, during the study period. Of these, 46.7% were high-risk, and 53.3% were low-risk. In the high-risk group, we found that patients (38 vs. 20, p=0.0005) required a longer length of hospital stay and an increased frequency of PICU admissions (11.7% vs. 3%, p=0.02) and mechanical ventilation (8.2% vs. 0 p=0.03) compared to the low-risk group. We found that the patients who required a more extended hospital stay were associated with an identified infection in 85% (p=0.043) of the cases and positive blood culture in 25% (p=0.015) in the low-risk group. In the patients considered low risk requiring PICU admission, we found that they were associated with a severe infection and positive blood cultures in all the cases.
Conclusions
The risk stratification proposed by Santolaya et al. is easy to apply in our setting. Patients at low-risk FN show lower frequencies of admission to the PICU and shorter hospital stays. Prospective studies are necessary to evaluate the feasibility of offering an outpatient-based treatment for this group.