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Hospital discharges for fever and neutropenia in pediatric cancer patients: United States, 2009.

Mueller EL, Walkovich KJ, Mody R, Gebremariam A, Davis MM - BMC Cancer (2015)

Bottom Line: Upper respiratory infection (6.0 %) and acute otitis media (AOM) (3.7 %) were the most common infections associated with SLOS.Factors significantly associated with SLOS included living in the Midwest region (OR = 1.65, 1.22-2.24) or West region (OR 1.54, 1.11-2.14) versus Northeast, having a diagnosis of AOM (OR = 1.39, 1.03-1.87) or viral infection (OR = 1.63, 1.18-2.25) versus those without those comorbidities, and having a soft tissue sarcoma (OR = 1.47, 1.05-2.04), Hodgkin lymphoma (OR = 2.33, 1.62-3.35), or an ovarian/testicular tumor (OR = 1.76, 1.05-2.95) compared with patients without these diagnoses.SLOS admissions are rarely associated with serious infections, but contribute substantially to the burden of hospitalization for pediatric FN.

View Article: PubMed Central - PubMed

Affiliation: Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, Suite 4099C, Indianapolis, IN, 46202, USA. elmuelle@iupui.edu.

ABSTRACT

Background: Fever and neutropenia (FN) is a common complication of pediatric cancer treatment, but hospital utilization patterns for this condition are not well described.

Methods: Data were analyzed from the Kids' Inpatient Database (KID), an all-payer US hospital database, for 2009. Pediatric FN patients were identified using: age ≤19 years, urgent or emergent admit type, non-transferred, and a combination of ICD-9-CM codes for fever and neutropenia. Sampling weights were used to permit national inferences.

Results: Pediatric cancer patients accounted for 1.5 % of pediatric hospital discharges in 2009 (n = 110,967), with 10.1 % of cancer-related discharges meeting FN criteria (n = 11,261). Two-fifths of FN discharges had a "short length of stay" (SLOS) of ≤3 days, which accounted for approximately $65.5 million in hospital charges. Upper respiratory infection (6.0 %) and acute otitis media (AOM) (3.7 %) were the most common infections associated with SLOS. Factors significantly associated with SLOS included living in the Midwest region (OR = 1.65, 1.22-2.24) or West region (OR 1.54, 1.11-2.14) versus Northeast, having a diagnosis of AOM (OR = 1.39, 1.03-1.87) or viral infection (OR = 1.63, 1.18-2.25) versus those without those comorbidities, and having a soft tissue sarcoma (OR = 1.47, 1.05-2.04), Hodgkin lymphoma (OR = 2.33, 1.62-3.35), or an ovarian/testicular tumor (OR = 1.76, 1.05-2.95) compared with patients without these diagnoses.

Conclusion: FN represents a common precipitant for hospitalizations among pediatric cancer patients. SLOS admissions are rarely associated with serious infections, but contribute substantially to the burden of hospitalization for pediatric FN.

No MeSH data available.


Related in: MedlinePlus

Case selection strategy for “Fever and Neutropenia” – Kids’ Inpatient Database for 2009
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Fig1: Case selection strategy for “Fever and Neutropenia” – Kids’ Inpatient Database for 2009

Mentions: One of the aims of our study was to identify febrile neutropenic patient discharges associated with a relatively short, uneventful inpatient course and to assess variables associated with these discharges. Discharges with a short LOS would be potential candidates for future outpatient management strategies. Patients who develop fever while inpatient are traditionally considered high risk and would not qualify for early discharge or outpatient management strategies [14]. Therefore, to define a discharge encounter for “fever and neutropenia” (FN), the following criteria were applied: age ≤19 years, admit type either urgent or emergent (i.e., excluded elective admissions), and combination of ICD-9-CM discharge diagnosis of fever (780.6, 780.60, 780.61) and “neutropenia” (neutropenia [288.0], pancytopenia [284.1], or decreased white blood cell count [112.5]) in any of the discharge diagnosis fields (Fig. 1).Fig. 1


Hospital discharges for fever and neutropenia in pediatric cancer patients: United States, 2009.

Mueller EL, Walkovich KJ, Mody R, Gebremariam A, Davis MM - BMC Cancer (2015)

Case selection strategy for “Fever and Neutropenia” – Kids’ Inpatient Database for 2009
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4494157&req=5

Fig1: Case selection strategy for “Fever and Neutropenia” – Kids’ Inpatient Database for 2009
Mentions: One of the aims of our study was to identify febrile neutropenic patient discharges associated with a relatively short, uneventful inpatient course and to assess variables associated with these discharges. Discharges with a short LOS would be potential candidates for future outpatient management strategies. Patients who develop fever while inpatient are traditionally considered high risk and would not qualify for early discharge or outpatient management strategies [14]. Therefore, to define a discharge encounter for “fever and neutropenia” (FN), the following criteria were applied: age ≤19 years, admit type either urgent or emergent (i.e., excluded elective admissions), and combination of ICD-9-CM discharge diagnosis of fever (780.6, 780.60, 780.61) and “neutropenia” (neutropenia [288.0], pancytopenia [284.1], or decreased white blood cell count [112.5]) in any of the discharge diagnosis fields (Fig. 1).Fig. 1

Bottom Line: Upper respiratory infection (6.0 %) and acute otitis media (AOM) (3.7 %) were the most common infections associated with SLOS.Factors significantly associated with SLOS included living in the Midwest region (OR = 1.65, 1.22-2.24) or West region (OR 1.54, 1.11-2.14) versus Northeast, having a diagnosis of AOM (OR = 1.39, 1.03-1.87) or viral infection (OR = 1.63, 1.18-2.25) versus those without those comorbidities, and having a soft tissue sarcoma (OR = 1.47, 1.05-2.04), Hodgkin lymphoma (OR = 2.33, 1.62-3.35), or an ovarian/testicular tumor (OR = 1.76, 1.05-2.95) compared with patients without these diagnoses.SLOS admissions are rarely associated with serious infections, but contribute substantially to the burden of hospitalization for pediatric FN.

View Article: PubMed Central - PubMed

Affiliation: Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, Suite 4099C, Indianapolis, IN, 46202, USA. elmuelle@iupui.edu.

ABSTRACT

Background: Fever and neutropenia (FN) is a common complication of pediatric cancer treatment, but hospital utilization patterns for this condition are not well described.

Methods: Data were analyzed from the Kids' Inpatient Database (KID), an all-payer US hospital database, for 2009. Pediatric FN patients were identified using: age ≤19 years, urgent or emergent admit type, non-transferred, and a combination of ICD-9-CM codes for fever and neutropenia. Sampling weights were used to permit national inferences.

Results: Pediatric cancer patients accounted for 1.5 % of pediatric hospital discharges in 2009 (n = 110,967), with 10.1 % of cancer-related discharges meeting FN criteria (n = 11,261). Two-fifths of FN discharges had a "short length of stay" (SLOS) of ≤3 days, which accounted for approximately $65.5 million in hospital charges. Upper respiratory infection (6.0 %) and acute otitis media (AOM) (3.7 %) were the most common infections associated with SLOS. Factors significantly associated with SLOS included living in the Midwest region (OR = 1.65, 1.22-2.24) or West region (OR 1.54, 1.11-2.14) versus Northeast, having a diagnosis of AOM (OR = 1.39, 1.03-1.87) or viral infection (OR = 1.63, 1.18-2.25) versus those without those comorbidities, and having a soft tissue sarcoma (OR = 1.47, 1.05-2.04), Hodgkin lymphoma (OR = 2.33, 1.62-3.35), or an ovarian/testicular tumor (OR = 1.76, 1.05-2.95) compared with patients without these diagnoses.

Conclusion: FN represents a common precipitant for hospitalizations among pediatric cancer patients. SLOS admissions are rarely associated with serious infections, but contribute substantially to the burden of hospitalization for pediatric FN.

No MeSH data available.


Related in: MedlinePlus