National Trends in Hospitalization for Fever and Neutropenia in Children with Cancer, 2007-2014

Lekshminarayanan, Anusha; Bhatt, Parth; Linga, Vijay Gandhi; Chaudhari, Riddhi; Zhu, B. X.; Dave, Maneesh; Donda, Keyur; Savani, Sejal; Patel, Samir; Billimoria, Zeenia; Bhaskaran, Smita; Zaid-Kaylani, Samer; Dapaah‐Siakwan, Fredrick; Bhatt, Neel S.

doi:10.1016/j.jpeds.2018.06.056

Cited by 19 publications

(29 citation statements)

References 24 publications

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“… 32 , 34 , 35 Patient-related factors found to increase the likelihood of hospitalization included younger age (especially <10 years old), male, non-Hispanic white ethnicity, and having private rather than public health insurance. 31 , 32 , 34 , 35 Disease-related risk factors consisted of primary diagnosis of acute lymphoblastic leukemia and higher numbers of chronic conditions. 32 , 34 , 35 Moreover, a higher risk of hospitalization was observed in patients admitted through the ED, and those presenting to institutions in the Midwest or Western regions.…”

Section: Resultsmentioning

confidence: 99%

Chemotherapy-Induced Neutropenia and Febrile Neutropenia in the US: A Beast of Burden That Needs to Be Tamed?

et al. 2022

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Neutropenia and febrile neutropenia (FN) are common complications of myelosuppressive chemotherapy. This review provides an up-to-date assessment of the patient and cost burden of chemotherapy-induced neutropenia/FN in the US, and summarizes recommendations for FN prophylaxis, including the interim guidance that was recommended during the coronavirus disease 2019 (COVID-19) pandemic. This review indicates that neutropenia/FN place a significant burden on patients in terms of hospitalizations and mortality. Most patients with neutropenia/FN presenting to the emergency department will be hospitalized, with an average length of stay of 6, 8, and 10 days for elderly, pediatric, and adult patients, respectively. Reported in-hospital mortality rates for neutropenia/FN range from 0.4% to 3.0% for pediatric patients with cancer, 2.6% to 7.0% for adults with solid tumors, and 7.4% for adults with hematologic malignancies. Neutropenia/FN also place a significant cost burden on US healthcare systems, with average costs per neutropenia/FN hospitalization estimated to be up to $40 000 for adult patients and $65 000 for pediatric patients. Evidence-based guidelines recommend prophylactic granulocyte colony-stimulating factors (G-CSFs), which have been shown to reduce FN incidence while improving chemotherapy dose delivery. Availability of biosimilars may improve costs of care. Efforts to decrease hospitalizations by optimizing outpatient care could reduce the burden of neutropenia/FN; this was particularly pertinent during the COVID-19 pandemic since avoidance of hospitalization was needed to reduce exposure to the virus, and resulted in the adaptation of recommendations to prevent FN, which expanded the indications for G-CSF and/or lowered the threshold of use to >10% risk of FN.

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Section: Resultsmentioning

confidence: 99%

Chemotherapy-Induced Neutropenia and Febrile Neutropenia in the US: A Beast of Burden That Needs to Be Tamed?

et al. 2022

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“…The NIS has been used to estimate population-level trends in numerous conditions. [15][16][17][18][19] Researchers and policymakers use the NIS to make national estimates of health care use, access, charges, quality, and outcomes. The NIS is released annually, which makes it an excellent database for longitudinal analysis.…”

Section: Methods Databasementioning

confidence: 99%

National Trends in the Epidemiology and Resource Use for Henoch-Schönlein Purpura (IgA Vasculitis) Hospitalizations in the United States From 2006 to 2014

Yagnik

Jain

Amponsah³

et al. 2019

Hospital Pediatrics

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We examined the trends in the rate of Henoch-Schönlein purpura (HSP) hospitalizations and the associated resource use among children in the United States from 2006 through 2014. METHODS: Pediatric hospitalizations with HSP were identified by using International Classification of Diseases, Ninth Revision, code 287.0 from the National Inpatient Sample. HSP hospitalization rate was calculated by using the US population as the denominator. Resource use was determined by length of stay (LOS) and hospital cost. We used linear regression for trend analysis. RESULTS: A total of 16 865 HSP hospitalizations were identified, and the HSP hospitalization rate varied by age, sex, and race. The overall HSP hospitalization rate was 2.4 per 100 000 children, and there was no trend during the study period. LOS remained stable at 2.

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“…Severe neutropenia in our cohort was associated with higher rate of mortality. Studies report mortality for patients with fever and neutropenia as high as 75% ( 43 ). Specific comparative studies of patients with and without covid and neutropenia are necessary.…”

Section: Discussionmentioning

confidence: 99%

Association of Cancer Diagnosis and Therapeutic Stage With Mortality in Pediatric Patients With COVID-19, Prospective Multicenter Cohort Study From Latin America

et al. 2022

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BackgroundChildren with cancer are at risk of critical disease and mortality from COVID-19 infection. In this study, we describe the clinical characteristics of pediatric patients with cancer and COVID-19 from multiple Latin American centers and risk factors associated with mortality in this population.MethodsThis study is a multicenter, prospective cohort study conducted at 12 hospitals from 6 Latin American countries (Argentina, Bolivia, Colombia, Ecuador, Honduras and Peru) from April to November 2021. Patients younger than 14 years of age that had an oncological diagnosis and COVID-19 or multisystemic inflammatory syndrome in children (MIS-C) who were treated in the inpatient setting were included. The primary exposure was the diagnosis and treatment status, and the primary outcome was mortality. We defined “new diagnosis” as patients with no previous diagnosis of cancer, “established diagnosis” as patients with cancer and ongoing treatment and “relapse” as patients with cancer and ongoing treatment that had a prior cancer-free period. A frequentist analysis was performed including a multivariate logistic regression for mortality.ResultsTwo hundred and ten patients were included in the study; 30 (14%) died during the study period and 67% of patients who died were admitted to critical care. Demographics were similar in survivors and non-survivors. Patients with low weight for age (<-2SD) had higher mortality (28 vs. 3%, p = 0.019). There was statistically significant difference of mortality between patients with new diagnosis (36.7%), established diagnosis (1.4%) and relapse (60%), (p <0.001). Most patients had hematological cancers (69%) and they had higher mortality (18%) compared to solid tumors (6%, p= 0.032). Patients with concomitant bacterial infections had higher mortality (40%, p = 0.001). MIS-C, respiratory distress, cardiovascular symptoms, altered mental status and acute kidney injury on admission were associated with higher mortality. Acidosis, hypoxemia, lymphocytosis, severe neutropenia, anemia and thrombocytopenia on admission were also associated with mortality. A multivariate logistic regression showed risk factors associated with mortality: concomitant bacterial infection OR 3 95%CI (1.1–8.5), respiratory symptoms OR 5.7 95%CI (1.7–19.4), cardiovascular OR 5.2 95%CI (1.2–14.2), new cancer diagnosis OR 12 95%CI (1.3–102) and relapse OR 25 95%CI (2.9–214).ConclusionOur study shows that pediatric patients with new onset diagnosis of cancer and patients with relapse have higher odds of all-cause mortality in the setting of COVID-19. This information would help develop an early identification of patients with cancer and COVID-19 with higher risk of mortality.

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National Trends in Hospitalization for Fever and Neutropenia in Children with Cancer, 2007-2014

Cited by 19 publications

References 24 publications

Chemotherapy-Induced Neutropenia and Febrile Neutropenia in the US: A Beast of Burden That Needs to Be Tamed?

Chemotherapy-Induced Neutropenia and Febrile Neutropenia in the US: A Beast of Burden That Needs to Be Tamed?

National Trends in the Epidemiology and Resource Use for Henoch-Schönlein Purpura (IgA Vasculitis) Hospitalizations in the United States From 2006 to 2014

Association of Cancer Diagnosis and Therapeutic Stage With Mortality in Pediatric Patients With COVID-19, Prospective Multicenter Cohort Study From Latin America

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