Emergency Department Chief Complaints Among Children With Cancer

Burcham, Megan D; Cochrane, Anneli R; Jacob, Seethal A.; Carroll, Aaron E.; Mueller, Emily L.

doi:10.1097/mph.0000000000001223

Cited by 10 publications

(17 citation statements)

References 18 publications

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“…Yet for many institutions, the role of the ED is essential for triaging and managing urgent medical needs during nonbusiness hours. At our institution, only 56.5% of children with cancer who presented to the ED required admission, but of those admitted 6.2% required intensive care unit admission . While the ED provides necessary and timely assessment and treatment, the system may benefit from improvements at system and provider levels to improve upon those outcomes that are most important to children with cancer and their caregivers.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, children with cancer have a wide range of urgent medical needs, from fevers in the setting of neutropenia, to pneumonia, to seizures . Yet, only about half of patients who seek ED care require admission . Most children with cancer are treated at tertiary care hospitals but live closer to community‐based hospitals where they are often seen for urgent needs.…”

Section: Introductionmentioning

confidence: 99%

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Identifying patient‐centered outcomes for children with cancer and their caregivers when they seek care in the emergency department

Mueller

Cochrane

Lynch

et al. 2019

Pediatric Blood & Cancer

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Background: Children with cancer have high utilization of the emergency department (ED), but little is known about which outcomes are most important to them and their caregivers when they seek care in the ED.Procedure: A qualitative evaluation of ED experience for children with cancer and their caregivers was performed using self-reported interactive toolkits. Eligible participants included children with cancer (ages 11-19) and caregivers of children with cancer whose child received cancer therapy within the last year and had an ED visit within the last 2 years. Eligible participants received toolkits by mail and received incentives if they completed the toolkit. Toolkits were transcribed, thematically coded, and iteratively analyzed using Nvivo 11.0 software.Results: There were 26 toolkits received-seven by children aged 11-17 years and 19 by caregivers (11 with children aged 2-7 years, eight with children aged 11-17 years). About half were from within 1 h of their treating institution. The most important outcomes to this population included system-level issues (eg, cleanliness of space, timeliness of evaluation) and oncologyprovider-and ED-provider-level issues (eg, ability to access port-a-caths, quality of communication). Participants also identified outcomes that were within the control of the patient/caregiver, such as improving their sense of preparedness. Conclusion:The important outcomes to children with cancer and their caregivers when they seek care in the ED are distinct from current quality metrics. Future research should focus on the development and validation of a patient-centered outcomes tool. K E Y W O R D S outcomes research, pediatric oncology, support care 1 INTRODUCTION Children with cancer have high utilization of the emergency department (ED), with up to half seeking ED services during their therapy. 1,2 Among those with ED visits, 58% had four or more visits in the year after diagnosis. 3 Importantly, children with cancer have a wide range of urgent medical needs, from fevers in the setting of neutropenia, to pneumonia, to seizures. 2,4 Yet, only about half of patients who seek Abbreviations: ED, emergency department; IU, Indiana University; PCO, patient-centered outcome. ED care require admission. 2,4,5 Most children with cancer are treated at tertiary care hospitals but live closer to community-based hospitals where they are often seen for urgent needs. In a study on oncology providers' triaging practices, providers reported recommending patients travel further if they believed the local ED's ability to access a port-a-cath (port) and evaluation timeliness were "Poor" to "Fair." 6 This study highlights the need to evaluate the ED experience at both tertiary care and community EDs. when they seek ED services. Historically, researchers relied on clinician-determined outcomes (eg, length of stay, laboratory values, etc.) to decide how the delivery of care could be improved. 7-13 While traditional measures are imperative, patients and caregivers are arguably the most authoritative source i...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Identifying patient‐centered outcomes for children with cancer and their caregivers when they seek care in the emergency department

Mueller

Cochrane

Lynch

et al. 2019

Pediatric Blood & Cancer

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“…This approach has led to a significant reduction in mortality and morbidity [15], but consequently antibiotic overuse, increased risk of antimicrobial resistance, and prolonged hospitalisation. Fever accounts for 60.2% of emergency department (ED) attendance in paediatric cancer [16] and is a significant burden for caregivers [17] and healthcare systems. Commonly used biomarkers such as C-reactive protein (CRP) and procalcitonin aid the diagnostic process, but are often not sensitive enough to rule out bacterial infection [18,19].…”

Section: Introductionmentioning

confidence: 99%

Febrile illness in high-risk children: a prospective, international observational study

et al. 2022

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To assess and describe the aetiology and management of febrile illness in children with primary or acquired immunodeficiency at high risk of serious bacterial infection, as seen in emergency departments in tertiary hospitals. Prospective data on demographics, presenting features, investigations, microbiology, management, and outcome of patients within the ‘Biomarker Validation in HR patients’ database in PERFORM, were analysed. Immunocompromised children (< 18 years old) presented to fifteen European hospitals in nine countries, and one Gambian hospital, with fever or suspected infection and clinical indication for blood investigations. Febrile episodes were assigned clinical phenotypes using the validated PERFORM algorithm. Logistic regression was used to assess the effect size of predictive features of proven/presumed bacterial or viral infection. A total of 599 episodes in 482 children were analysed. Seventy-eight episodes (13.0%) were definite bacterial, 67 episodes probable bacterial (11.2%), and 29 bacterial syndrome (4.8%). Fifty-five were definite viral (9.2%), 49 probable viral (8.2%), and 23 viral syndrome (3.8%). One hundred ninety were unknown bacterial or viral infections (31.7%), and 108 had inflammatory or other non-infectious causes of fever (18.1%). Predictive features of proven/presumed bacterial infection were ill appearance (OR 3.1 (95% CI 2.1–4.6)) and HIV (OR 10.4 (95% CI 2.0–54.4)). Ill appearance reduced the odds of having a proven/presumed viral infection (OR 0.5 (95% CI 0.3–0.9)). A total of 82.1% had new empirical antibiotics started on admission (N = 492); 94.3% proven/presumed bacterial (N = 164), 66.1% proven/presumed viral (N = 84), and 93.2% unknown bacterial or viral infections (N = 177). Mortality was 1.9% (N = 11) and 87.1% made full recovery (N = 522). Conclusion: The aetiology of febrile illness in immunocompromised children is diverse. In one-third of cases, no cause for the fever will be identified. Justification for standard intravenous antibiotic treatment for every febrile immunocompromised child is debatable, yet effective. Better clinical decision-making tools and new biomarkers are needed for this population. What is Known:• Immunosuppressed children are at high risk for morbidity and mortality of serious bacterial and viral infection, but often present with fever as only clinical symptom.• Current diagnostic measures in this group are not specific to rule out bacterial infection, and positivity rates of microbiological cultures are low. What is New:• Febrile illness and infectious complications remain a significant cause of mortality and morbidity in HR children, yet management is effective.• The aetiology of febrile illness in immunocompromised children is diverse, and development of pathways for early discharge or cessation of intravenous antibiotics is debatable, and requires better clinical decision-making tools and biomarkers.

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“…[11][12][13] Hence, emergency department (ED) utilization and hospital admissions are higher in pediatric patients with cancer compared to the general pediatric population. 14 More than 40% of pediatric patients with cancer use ED services for cancer-related and unrelated care needs. 10,11,13,15 In addition, about half of ED visits among these patients further result in a hospital admission, which are disproportionately higher than the overall pediatric population.…”

Section: Introductionmentioning

confidence: 99%

“…10,11,13,15 Beyond common clinical reasons that prompt ED visits among pediatric patients with cancer, previous work has documented differences in ED utilization and disposition outcomes across socioeconomically diverse pediatric patients with cancer. 11,[14][15][16][17] In particular, lack of health insurance coverage and residence in lower income areas have been associated with lower odds of hospital admission through the ED among pediatric patients with cancer . 11,17 These findings indicate that socioeconomically vulnerable pediatric patients with cancer are not exempt from well-documented disparities in health outcomes.…”

Section: Introductionmentioning

confidence: 99%

Emergency department utilization and disposition outcomes by pediatric patients with cancer in Maryland and New York from 2013 to 2017

Christodoulou

Dietrich

Hair

et al. 2023

Pediatric Blood & Cancer

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Background Pediatric patients with cancer commonly seek emergency department (ED) care, yet there is limited evidence on ED utilization patterns and disposition outcomes among these patients. Methods Retrospective analysis of the Healthcare Cost and Utilization Project State Emergency Department Databases and State Inpatient Databases for Maryland and New York from 2013 to 2017. We compared ED visits and disposition outcomes for 5.8 million pediatric patients (<18 years old) with and without cancer, and used multivariable regressions to estimate associations between the number of ED visits, hospital (inpatient) admissions through the ED, and ED or inpatient mortality and sociodemographic and clinical factors within the cancer cohort. Results Pediatric patients with cancer had more ED visits per year on average (2.4 vs. 1.5, p < .001), higher shares of admissions (56.8% vs. 6.6%, p < .001) and mortality (1.2% vs. 0.1%, p < .001) compared to those without cancer. Among patients with cancer, uninsured pediatric patients had fewer ED visits and lower risk of admission to a hospital through the ED compared to those with Medicaid coverage (total visits: incidence rate ratio [IRR]: 0.82, 95% confidence intervals [CI]: 0.75–0.90; admission: IRR: 0.75, 95% CI: 0.65–0.86). Mortality risks were higher for pediatric patients with cancer residing in areas with the lowest median household income, and with no health insurance coverage (IRR: 2.81, 95% CI: 1.21–6.51) compared to Medicaid. Conclusions Our findings emphasize the importance of enhancing health insurance coverage policies and social services for pediatric patients with cancer and their families to address clinical and nonclinical needs.

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Emergency Department Chief Complaints Among Children With Cancer

Cited by 10 publications

References 18 publications

Identifying patient‐centered outcomes for children with cancer and their caregivers when they seek care in the emergency department

Identifying patient‐centered outcomes for children with cancer and their caregivers when they seek care in the emergency department

Febrile illness in high-risk children: a prospective, international observational study

Emergency department utilization and disposition outcomes by pediatric patients with cancer in Maryland and New York from 2013 to 2017

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