Children with Cancer, Fever, and Treatment-Induced Neutropenia: Risk Factors Associated with Illness Requiring the Administration of Critical Care Therapies

Daniel C. West, James P Marcin, Roland Mawis, Jingsong He, Audrey Nagle, Robert Dimand

Research output: Contribution to journalArticle

25 Scopus citations

Abstract

Objectives: To identify clinical and laboratory characteristics of pediatric patients with cancer, fever, and treatment-induced neutropenia, available at initial presentation, that are independently associated with the development of illnesses requiring administration of critical care therapies. Methods: We retrospectively collected historical, clinical, and laboratory data on initial presentation for all pediatric (younger than 18 years) cancer patients admitted for fever and treatment-induced neutropenia at our institution over a 5-year period. The outcome variable was the need for administration of a critical care therapy within 24 hours of admission. A multivariable analysis was performed and internally validated using bootstrap analysis. Results: We identified 303 events in 143 patients, of which 36 (11.9%) received a critical care therapy. Higher temperature at presentation and capillary filling time (CFT) of >3 seconds retained significance in the multivariable analysis and were validated by the bootstrap analysis. The positive and negative predictive values of the presence of either temperature of ≥39.5°C or CFT of >3 seconds were 35% and 91%, respectively. Conclusions: Pediatric patients with cancer, fever, and treatment-induced neutropenia who present with higher fever or prolonged CFT are at increased risk of developing life-threatening illnesses requiring administration of critical care therapies, independent of hematologic factors, type of cancer, or other physiologic signs of sepsis.

Original languageEnglish (US)
Pages (from-to)79-84
Number of pages6
JournalPediatric Emergency Care
Volume20
Issue number2
DOIs
StatePublished - Feb 2004

Keywords

  • Cancer
  • Critical illness
  • Fever and neutropenia
  • Risk factors

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nursing(all)
  • Emergency Medicine

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