Pediatric Emergency Care for Children and Adolescents with Cancer: Causes of Consultation and Factors Associated with Hospitalization
DOI:
https://doi.org/10.32635/2176-9745.RBC.2023v69n4.4076Keywords:
febrile neutropenia, medical oncology, emergency medical services, children, adolescentAbstract
Introduction: Pediatric emergency care is essential for adequate medical treatment of pediatric cancer-associated complications and for increasing the chances of cure. Objective: This study aimed to describe pediatric cancer-associated emergencies and outcomes, and to analyze the factors associated with hospitalization. Method: A retrospective observational cohort study was conducted including patients aged ≤19 years who attended the pediatric emergency of a general cancer hospital from April 17 to October 17, 2019. The variables analyzed were demographics, socioeconomic status, disease and treatment factors, reasons for seeking emergency care, and associated outcomes. Results: This study included 309 patients who required 994 emergency consultations, with a total of 766 reasons for seeking care. The median age was 4.86 years; 50.8% were female and 51.5% were white. The patients had solid tumors (49.8%), central nervous system tumors (27.5%), and hematological neoplasms (15.5%). Most of the patients were home discharged (72.2%) or to support houses (6.7%). Fever was the most frequent symptom (30.8%) and the most common reason for admission. 19.2% of the patients were admitted to the ward and 2.0% to the pediatric intensive care unit (2.0%). Only two of the 309 patients (0.6%) seeking care in the pediatric emergency died in the emergency room, and these patients were in end-of-life care. Conclusion: The availability of a pediatric emergency room with skilled professionals in supportive care of pediatric patients with cancer was essential for the management of disease and treatment-related complications.
Downloads
References
Instituto Nacional de Cancer. Estimativa 2023: incidencia de cancer no Brasil [Internet]. Rio de Janeiro: INCA; 2022. [cited 2023 jan 21]. Disponível em: https://www.inca.gov.br/sites/ufu.sti.inca.local/files/media/document/estimativa-2023.pdf
Instituto Nacional de Câncer. Incidência, mortalidade e morbidade hospitalar por câncer em crianças, adolescentes e adultos jovens no Brasil: informações dos registros de câncer e do sistema de mortalidade [Internet]. Rio de Janeiro: INCA; 2016 [cited 2020 jan 21]. Available from: https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//incidencia-mortalidade-morbidade-hospitalar-por-cancer.pdf
Kaul S, Russell H, Livingston JA, et al. Emergency department visits by adolescent and young adult cancer patients compared with pediatric cancer patients in the united states. J Adolesc Young Adult Oncol. 2018;7(5):553-64. doi: https://doi.org/10.1089/jayao.2018.0026
Mueller EL, Hall M, Shah SS, et al. Characteristics of children with cancer discharged or admitted from the emergency department. Pediatr Blood Cancer. 2016;63(5):853-8. doi: http://doi.wiley.com/10.1002/pbc.25872
Stephanos K, Dubbs SB. Pediatric hematologic and oncologic emergencies. Emerg Med Clin North Am. 2021;39(3):555-71. doi: https://doi.org/10.1016/j.emc.2021.04.007
Prusakowski MK, Cannone D, Stephanos K, et al. Pediatric oncologic emergencies. Emerg Med Clin North Am. 2014;32(3):527-48. doi: https://doi.org/10.1016/j.emc.2021.04.007
Sung L. Priorities for quality care in pediatric oncology supportive care. J Oncol Pract. 2015;11(3):187-9. https://doi.org/10.1200/JOP.2014.002840
Mueller EL, Sabbatini A, Gebremariam A, et al. Why pediatric patients with cancer visit the emergency department: United States, 2006-2010. Pediatr Blood Cancer. 2015;62(3):490–5. doi: http://doi.wiley.com/10.1002/pbc.25288
Lehrnbecher T, Robinson PD, Ammann RA, et al. Guideline for the management of fever and neutropenia in pediatric patients with cancer and hematopoietic cell transplantation recipients: 2023 Update. J Clin Oncol. 2023;41(9):1774-85. doi: https://doi.org/10.1200/JCO.22.02224
Mueller EL, Walkovich KJ, Yanik GA, et al. Variation in management of fever and neutropenia among pediatric patients with cancer: a survey of providers in michigan. Pediatr Hematol Oncol. 2015;32(5):331-40. doi: https://doi.org/10.3109/08880018.2015.1036331
Conselho Nacional de Saúde (BR). Resolução n° 466, de 12 de dezembro de 2012. Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Diário Oficial da União, Brasília, DF. 2013 jun 13; Seção I:59.
Instituto Nacional do Câncer [Internet]. About Inca Institutional [Internet]. [cited 2022 jan 21]. Available from: https://www.inca.gov.br/institucional
Castro MC, Massuda A, Almeida G, et al. Brazil’s unified health system: the first 30 years and prospects for the future. Lancet. 2019;394(10195):345-56.
Ferman S, Lima FFDS, Lage CRS, et al. Preventing treatment abandonment for children with solid tumors: a single-center experience in Brazil. Pediatr Blood Cancer. 2019;66(7):1-7.
Ronald McDonald Institute [Internet]. About. [cited 2022 jan 21]. Available from: https://institutoronald.org.br/o_que_nos_fazemos/casas-ronald-mcdonald/
Steliarova-Foucher E, Stiller C, Lacour B, et al. International classification of childhood cancer, third edition. Cancer. 2005;103:1457-67.
Klemencic S, Perkins J. Diagnosis and management of oncologic emergencies. West J Emerg Med. 2019;20(2):316-22. https://doi.org/10.5811/westjem.2018.12.37335
Mueller EL, Hall M, Carroll AE, et al. Frequent emergency department utilizers among children with cancer. Pediatr Blood Cancer. 2016;63(5):859-64. doi: http://doi.wiley.com/10.1002/pbc.25929
Burcham MD, Cochrane AR, Jacob SA, et al. Emergency department chief complaints among children with cancer. J Pediatr Hematol Oncol. 2018;40(6):445-9. Available from: https://doi.org/10.1097/MPH.0000000000001223
Çiftçi AÇ, Küpeli S, Sezgin G, et al. Evaluation of pediatric patients with an oncologic emergency: single center experience. Turk J Pediatr. 2018;60(6):660. https://doi.org/10.24953/turkjped.2018.06.006
Henry M, Sung L. Supportive care in pediatric oncology. Pediatr Clin North Am. 2015;62(1):27-46. doi: http://dx.doi.org/10.1016/j.pcl.2014.09.016
Janssens KP, Valete COS, Silva ARA, et al. Evaluation of risk stratification strategies in pediatric patients with febrile neutropenia. J Pediatr (Rio J). 2020;97(3):302-8. doi: https://doi.org/10.1016/j.jped.2020.05.002
Gaucher N, Humbert N, Gauvin F. What do we know about pediatric palliative care patients consulting to the pediatric emergency department? Pediatr Emerg Care. 2021;37(7):e396-e400. doi: http://dx.doi.org/10.1097/PEC.0000000000001620
O’Meara M, Trethewie S. Managing paediatric death in the emergency department. J Paediatr Child Health. 2016;52(2):164-7. doi: http://doi.wiley.com/10.1111/jpc.12957
Published
How to Cite
Issue
Section
License
Os direitos morais e intelectuais dos artigos pertencem aos respectivos autores, que concedem à RBC o direito de publicação.
This work is licensed under a Creative Commons Attribution 4.0 International License.
