Can We Safely Discharge Low-Risk Patients With Febrile Neutropenia From the Emergency Department?

Mamtani, Mira; Conlon, Lauren W.

doi:10.1016/j.annemergmed.2013.07.006

Cited by 11 publications

(13 citation statements)

References 10 publications

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“…Over half of ED visits for adult cancer patients resulted in admission . Given an interest in reducing these high admission rates, there are recent publications exploring the safety of direct ED discharge for adult cancer patients with FN . To date, existing literature on pediatric patients with cancer has predominantly focused on outcomes among hospitalized patients without an acknowledgement of the ED management prior to admission.…”

Section: Introductionmentioning

confidence: 99%

Why pediatric patients with cancer visit the emergency department: United States, 2006–2010

Mueller

Sabbatini

Gebremariam

et al. 2014

Pediatric Blood & Cancer

108

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BACKGROUND Little is known about emergency department (ED) use among pediatric patients with cancer. We explored reasons prompting emergency department (ED) visits and factors associated with hospital admission. PROCEDURE A retrospective cohort analysis of pediatric ED visits from 2006-2010 using the Nationwide Emergency Department Sample, the largest all-payer database of United States ED visits. Pediatric patients with cancer (ages ≤19 years) were identified using Clinical Classification Software. Proportion of visits and disposition for the top ten-ranking non-cancer diagnoses were determined. Weighted multivariate logistic regression was performed to analyze factors associated with admission versus discharge. RESULTS There were 294,289 ED visits by pediatric patients with cancer in the US over the study period. Fever and fever with neutropenia (FN) were the two most common diagnoses, accounting for almost 20% of visits. Forty-four percent of pediatric patients with cancer were admitted to the same hospital, with admission rates up to 82% for FN. Risk factors for admission were: FN (odds ratio (OR) 8.58; 95% confidence interval (CI) 5.97-12.34); neutropenia alone (OR 7.28; 95% CI 5.08-10.43), ages 0-4 years compared with 15-19 years (OR 1.19; 95% CI 1.08-1.31) and highest median household income ZIP code (OR 1.27; 95% CI 1.08-1.49) compared with lowest. “Self-pay” visits had lower odds of admission (OR 0.42; 95% CI 0.35-0.51) compared with public payer. CONCLUSION FN was the most common reason for ED visits among pediatric patients with cancer and is the condition most strongly associated with admission. Socioeconomic factors appear to influence ED disposition for this population.

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Section: Introductionmentioning

confidence: 99%

Why pediatric patients with cancer visit the emergency department: United States, 2006–2010

Mueller

Sabbatini

Gebremariam

et al. 2014

Pediatric Blood & Cancer

108

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“…The available evidence, though limited, suggests that low-risk oncologic febrile neutropenia patients can be managed as an outpatient [11]. With efforts to reduce acute inpatient care, our study suggests that there is an opportunity to identify oncologic febrile neutropenia patients who can be appropriately cared for outside the hospital.…”

Section: Discussionmentioning

confidence: 88%

A comparison of ED and direct admission care of cancer patients with febrile neutropenia

Owolabi

Rowland

King

et al. 2015

The American Journal of Emergency Medicine

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“…Two articles reported on the management of low‐risk neutropenic patients diagnosed with cancer in the ED. Mamtani and Conlon () reviewed three original research articles examining safety to discharge from ED low‐risk neutropenic patients receiving oral AB without a period of observation. Caution is needed when examining the outcomes of the three studies as they used different definitions of low‐risk FN patients.…”

Section: Resultsmentioning

confidence: 99%

Critical review of emergency department management of chemotherapy complications in cancer patients

Blanco

2018

Eur J Cancer Care

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Introduction Recent worldwide advances in cancer therapies have resulted in an increased number of people receiving chemotherapy in ambulatory care settings. In Spain, emergency departments are the single point of entry to acute inpatient services and they play a pivotal role in the management of chemotherapy complications. Little research exists in patterns of emergency department utilisation by oncology patients with chemotherapy‐related complications. However, it is important for the oncology patients and the healthcare system to gain understanding in the disease pathway and the organisational factors influencing the quality of care. Methods This critical review's main aims were to describe the clinical characteristics of patients who presented to an emergency department after chemotherapy treatment as reported in international literature; to map reported patterns of care in emergency department access; and quality of care exploring the management of febrile neutropenic patients described in the literature, against best practice guidelines. Results The search strategy yield 701 articles from MEDLINE, TROVE and SCOPUS and 26 were included. The review combines systematic reviews, observational, cross‐sectional case–control studies and randomised control trials. Conclusion All articles showed areas and opportunities for improvement in the management of this population, especially with regard to time from triage to antibiotic administration in febrile neutropenic patients.

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Can We Safely Discharge Low-Risk Patients With Febrile Neutropenia From the Emergency Department?

Cited by 11 publications

References 10 publications

Why pediatric patients with cancer visit the emergency department: United States, 2006–2010

Why pediatric patients with cancer visit the emergency department: United States, 2006–2010

A comparison of ED and direct admission care of cancer patients with febrile neutropenia

Critical review of emergency department management of chemotherapy complications in cancer patients

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