Incidence, severity, and preventability of adverse events during the induction of patients with acute lymphoblastic leukemia in a tertiary care pediatric hospital in Mexico

Abstract

Healthcare-associated adverse events represent a heavy burden of symptoms for pediatric oncology patients. Their description allows knowing the safety and quality of the care processes in countries with limited resources. This study aimed to describe the incidence, types, severity, and preventability of adverse events occurring in pediatric patients with acute lymphoblastic leukemia during the induction phase in a tertiary care pediatric hospital in Mexico. This study analyzed a cohort based on medical records of between 2015 and 2017. Initially, information on patients and adverse events was collected; subsequently, two pediatric oncologist reviewers independently classified adverse events, severity and preventability. Agreement between reviewers was evaluated. Adverse events incidence rates were estimated by type, severity, and preventability. One-hundred and eighty-one pediatric patients pediatric patients with acute lymphoblastic leukemia were studied. An overall adverse events rate of 51.8 per 1000 patient-days was estimated, involving 81.2% of patients during induction. Most adverse events were severe or higher (52.6%). Infectious processes were the most common severe or higher adverse event (30.5%). The presence of adverse events caused 80.2% of hospital readmissions. Of the adverse events, 10.5% were considered preventable and 53.6% could be ameliorable in severity. Improving the safety and quality of the care processes of children with acute lymphoblastic leukemia is possible, and this should contribute to the mitigation and prevention of adverse events associated morbidity and mortality during the remission induction phase.

Flow cytometric detection of leukemic blasts in Libyan pediatric patients with acute lymphoblastic leukemia

“…Our results have shown that B-ALL is the predominant type of leukemia affecting 57.9% of our cases, which is comparable to other studies [ 22–27 ]. On the other hand, the incidence of T-ALL represented 38.1% of all cases, which is approximately similar to that reported in Moroccan children (37%) [ 28 ], but is higher than reported in Mexico (6.1%) [ 26 ], Saudi Arabia (14.7%) [ 23 ], and Holland 14.0% [ 29 ]. In our study, T-ALL was more commonly found in males (79.3% of all T-ALL cases).…”

Survival estimates of childhood malignancies treated at the Mexican telethon pediatric oncology hospital

“…Actually, in a Mexican study of children with ALL treated using a DFCI protocol, 7% died during induction; deaths were associated with delays in hospital care, poor general conditions, tumor charge, malnutrition, infection, and treatment toxicity 41 . Moreover, a recent study from a major pediatric hospital in Mexico revealed the importance of improving the safety and quality of care of children with ALL; it was estimated that the incidence of adverse events (51.8/1000 patient‐days) linked to morbidity and mortality during the induction phase that can be prevented and mitigated was 10.5% and 53.6%, respectively 60 …”

“…41 Moreover, a recent study from a major pediatric hospital in Mexico revealed the importance of improving the safety and quality of care of children with ALL; it was estimated that the incidence of adverse events (51.8/1000 patient‐days) linked to morbidity and mortality during the induction phase that can be prevented and mitigated was 10.5% and 53.6%, respectively. 60 …”

“…41 Moreover, a recent study from a major pediatric hospital in Mexico revealed the importance of improving the safety and quality of care of children with ALL; it was estimated that the incidence of adverse events (51.8/1000 patient-days) linked to morbidity and mortality during the induction phase that can be prevented and mitigated was 10.5% and 53.6%, respectively. 60 Early relapse has also been used to predict survival. 46,[51][52][53] While no such correlation was observed for ALL using 18-month relapse in this study, a moderate correlation was seen between 12-month relapse and survival for TOCNS (r = 0.44) and TWCNS (r = 0.43).…”