Etiologies and Impact of Readmission Rates in the First 180 Days After Hematopoietic Stem Cell Transplantation in Children, Adolescents, and Young Adults

Maher, Ossama M.; Silva, Jorge G; Huh, Winston W.; Cuglievan, Branko; DePombo, April; Kebriaei, Partow; Park, Minjeong; Liu, Diane; Tillman, Chloe; Tarek, Nidale; Cooper, Laurence J.N.; Tewari, Priti

doi:10.1097/mph.0000000000000898

Cited by 7 publications

(3 citation statements)

References 14 publications

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“…Severe infections have remained an important cause of non‐relapse mortality (NRM) after allogeneic hematopoietic stem cell transplantation (HSCT) . Infections account for almost 30% of all hospital re‐admissions within the first 100 days after HSCT using myeloablative or reduced intensity conditioning …”

Section: Introductionmentioning

confidence: 99%

Allogeneic hematopoietic stem cell transplantation from unrelated donors is associated with higher infection rates in children with acute lymphoblastic leukemia—A prospective international multicenter trial on behalf of the BFM‐SG and the EBMT‐PDWP

et al. 2019

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Severe infections (SI) significantly impact on non‐relapse mortality after hematopoietic stem cell transplantation (HSCT). We assessed 432 children and adolescents with acute lymphoblastic leukemia (ALL) after total body irradiation based myeloablative HSCT within the multicenter ALL‐BFM‐SCT 2003 trial for SI grade 3 or higher according to common terminology criteria for adverse events. A total 172 patients experienced at least one SI. Transplantation from matched unrelated donors (MUD) was associated with any type of SI in the pre‐engraftment period (hazard ratio [HR]: 2.57; P < .001), and with any SI between day +30 and + 100 (HR: 2.91; P = .011). Bacterial (HR: 2.24; P = .041) and fungal infections (HR: 4.06; P = .057) occurred more often in the pre‐engraftment phase and viral infections more often before day +30 (HR: 2.66; P = .007) or between day +30 and + 100 (HR: 3.89; P = .002) after HSCT from MUD as compared to matched sibling donors. Chronic GvHD was an independent risk factor for any type of SI after day +100 (HR: 2.57; P < .002). We conclude that allogeneic HSCT from MUD in children and adolescents with pediatric ALL is associated with higher infection rates, which seems attributable to an intensified GvHD prophylaxis including serotherapy and methotrexate.

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Section: Introductionmentioning

confidence: 99%

Allogeneic hematopoietic stem cell transplantation from unrelated donors is associated with higher infection rates in children with acute lymphoblastic leukemia—A prospective international multicenter trial on behalf of the BFM‐SG and the EBMT‐PDWP

et al. 2019

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“…As in other articles 7,8,9 , fever was the leading cause of PED presentation, accounting for 1 out of every 3 care episodes. The median age of HCT patients was higher than the rest of the patients receiving care in the PED.…”

Section: Discussionmentioning

confidence: 51%

Characteristics and risk factors for admission in children undergoing hematopoietic cell transplantation in a pediatric emergency department

Cadenas

Andrés

Martínez

et al. 2021

Preprint

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We describe 68 hematopoietic cell transplantation (HCT) patients who visited our pediatric emergency department during 2014-2015 (188 encounters). Fever was the main complaint in 74 (34.8%) encounters. Diagnostic tests were performed in 147 (78.2%) episodes [100% of patients with unstable Pediatric Assessment Triangle (PAT) and 75.7% with stable PAT (P value 0.02)] and treatment was required in 93 (49.5%) episodes [15 (78.9%) with unstable PAT and 78 (46.2%) with stable PAT (P value <0.001)]. Risk factors for admission were unstable PAT [relative risk (RR) 3.4 (2.6-4.6), P value <0.001] and ≤100 days since HCT [RR 2.1 (1.4-3.1), P value <0.001].

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“…Caregiver coping decreases and their ability to understand extensive discharge information during the transition of care from hospital to home declines (Lerret et al, 2016;Richardson et al, 2018;Runaas et al, 2017;Wu et al, 2016). Substantial vulnerabilities for this population exist that greatly increase nonadherence to the posttransplant regimen leading to hospital readmissions within the first 30 days of discharge, lifethreatening complications, decreased quality of life, and even death (Gladbach et al, 2021;Maher et al, 2017;McKenna et al, 2015;Pai et al, 2018;Shulman et al, 2015;Spring et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Standardization of Pediatric Hematopoietic Stem Cell Transplant Patient Discharge to Reduce Readmission Rates

West,

Varnes,

Hudspeth

2023

Journal of Pediatric Hematology/Oncology Nursing

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Background: The time period after a pediatric hematopoietic stem cell transplant (P-HSCT) is tenuous as the patient is severely immunocompromised and awaiting immune reconstitution. Managing activities of daily living and medication administration after discharge from the hospital requires 24-hour care placing a heavy burden on caregivers and patients. Patients who do not adhere to the posttransplant regimen are at a higher risk for hospital readmission within the first 30 days of initial discharge with serious potential for life-threatening complications. The objective of this project was to improve 30-day readmission rates and caregiver readiness for discharge through the implementation of an evidence-based discharge protocol for P-HSCT patients and caregivers. Methods: This quality improvement project included development and implementation of comprehensive Pediatric Blood & Marrow Transplant Guidelines and discharge protocol for patients who received an inpatient autologous or allogeneic HSCT and were scheduled for discharge from a 16-bed inpatient pediatric hematology–oncology unit of a children's hospital in the southeastern United States. Readmission rates were captured through the hospital-monitored system. Results: The comprehensive discharge protocol was implemented for six patients, and 30-day readmission rates decreased from 27.29% to 3.57% following the intervention. Discussion: Results suggest the combination of an evidence-based discharge protocol with a focus on caregiver readiness for discharge and a 24-hour Rooming-In period can influence caregiver confidence and reduce 30-day readmission rates after initial discharge from a P-HSCT.

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Etiologies and Impact of Readmission Rates in the First 180 Days After Hematopoietic Stem Cell Transplantation in Children, Adolescents, and Young Adults

Abstract: More than 2 hospital readmissions within 6 months of allogeneic HSCT in CAYA, who are either heavily pretreated or had documented infections at index admission or subsequent readmissions adversely affected the outcomes.

Cited by 7 publications

References 14 publications

Allogeneic hematopoietic stem cell transplantation from unrelated donors is associated with higher infection rates in children with acute lymphoblastic leukemia—A prospective international multicenter trial on behalf of the BFM‐SG and the EBMT‐PDWP

Allogeneic hematopoietic stem cell transplantation from unrelated donors is associated with higher infection rates in children with acute lymphoblastic leukemia—A prospective international multicenter trial on behalf of the BFM‐SG and the EBMT‐PDWP

Characteristics and risk factors for admission in children undergoing hematopoietic cell transplantation in a pediatric emergency department

Standardization of Pediatric Hematopoietic Stem Cell Transplant Patient Discharge to Reduce Readmission Rates

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