Febril Nötropeni Hastalarında Acil Serviste Yatış İçin Bekleme Süresi Mortaliteyi Arttırır mı? – Retrospektif Gözlemsel Araştırma

Yıl 2022, , 99 - 102, 30.09.2022

Yunus Emre Özlüer , Fatma Dilan Güvenç

https://doi.org/10.54996/anatolianjem.1036089

Öz

Amaç: Acil serviste yatış için bekleyen febril nötropeni hastalarında, bekleme süresi ile hastane içi mortalite ve hastanede yatış süresi arasında herhangi bir ilişki olup olmadığını saptamak.

Gereç ve Yöntemler: Aydın Adnan Menderes Üniversitesi Tıp Fakültesi Acil Tıp Ana Bilim Dalı’na 01.04.2015-01.08.2019 arasında başvuran febril nötropeni tanısı almış hastaların demografik özellikleri ile başvuru sırasındaki lökosit ve nötrofil değerleri, acil serviste antibiyotik ve koloni stimülan faktör uygulanıp uygulanmadığı, acil serviste yatış için bekleme süresi, hastaların acil servisten yatışının yapıldığı bölüm (servis/yoğun bakım), hastanede kalış süreleri ve hastane içi mortalite durumları kaydedildi. Elde edilen verilerin mortalite ile hastanede kalış süresi arasındaki ilişkisi analiz edildi.

Bulgular: Çalışmaya dahil edilen 86 hastanın medyan yaşı 67 [IQR 17] ve erkek hasta oranı %52,3 (n=45) idi. Hastaların acil serviste yatış bekleme süresi medyan 6,7 [IQR 6,5] saat, solid organ malignitesi olan hasta sayısı 44 (%51,2), yoğun bakım yatışı yapılan hasta sayısı 20 (%23,3) olarak tespit edildi. Koloni stimülan faktör (CSF) uygulanan hasta sayısının 36 (%41,9), acil serviste antibiyotik tedavisi başlanan hasta sayısının 65 (%75,6) olduğu görüldü. Hastaların acil servise başvuru anındaki medyan lökosit sayısı 725/mm3 [IQR 705], medyan nötrofil sayısı ise 135/mm3 [IQR 237,5] olarak tespit edildi. Yapılan korelasyon analizinde acil serviste bekleyiş süresi ile hastane içi mortalite ve hastanede kalış süresi arasında bir korelasyon saptanmadı (sırasıyla p=0,480, p=0,768).

Sonuç: Febril nötropeni hastaları için acil servislerde uygun izolasyon koşulları ve gerekli sağlık bakım standartlarının sağlanması halinde yatış için bekleme süresi hastane içi mortalite ve hastanede kalış süresini etkilememektedir.

Anahtar Kelimeler

Febril nötropeni, acil servis, mortalite, bekleme süresi

Destekleyen Kurum

yok

Does Waiting Time for Hospitalization in the Emergency Department Increase Mortality in Patients with Febrile Neutropenia? – Retrospective Observational Research

Öz

Aim: To determine whether there is any relationship between waiting time and in-hospital mortality and length of stay in febrile neutropenia patients waiting for hospitalization in the emergency department (ED).

Material and Methods: Demographic characteristics of patients diagnosed with febrile neutropenia, who presented to Aydın Adnan Menderes University Faculty of Medicine, Department of Emergency Medicine between 01.04.2015 and 01.08.2019, their leukocyte and neutrophil counts at the time of admission, whether antibiotics and colony stimulating factors (CSF) were administered in the ED, the waiting time for the patient for hospitalization, the department where the patients were hospitalized from the ED (wards/intensive care units), length of hospital stay and in-hospital mortality were recorded. The relationship of the obtained data between in regards to mortality and length of hospital stay was analyzed.

Results: The median age of 86 patients included in the study was 67 [IQR 17] and 52.3% (n=45) of the patients were male. The median waiting time for hospitalization in the ED was 6.7 [IQR 6.5] hours, the number of patients with solid organ malignancy was 44 (51.2%), and the number of patients admitted to the intensive care unit was 20 (23.3%). The number of patients treated with CSF was 36 (41.9%), and the number of patients who started antibiotic treatment in the ED was 65 (75.6%). The median leukocyte count at the time of admission to the ED was 725/mm3 [IQR 705], and the median neutrophil count was 135/mm3 [IQR 237.5]. No correlation was found between the duration of waiting in the emergency room and in-hospital mortality and hospital stay (p=0.480, p=0.768, respectively).

Conclusion: The waiting period for hospitalization does not affect in-hospital mortality and length of stay in the emergency departments in patients with febrile neutropenia when appropriate isolation conditions and necessary health care standards are provided.

Anahtar Kelimeler

Febrile neutropenia, emergency room, mortality, waiting times

Kaynakça

• Carmona-Bayonas A, Jimenez-Fonseca P, de Castro EM, et al. SEOM clinical practice guideline: management and prevention of febrile neutropenia in adults with solid tumors (2018). Clin Transl Oncol. 2019;21(1):75-86. doi:10.1007/s12094-018-1983-4
• Baugh CW, Wang TJ, Caterino JM, et al. Emergency Department Management of Patients With Febrile Neutropenia: Guideline Concordant or Overly Aggressive? Mark Courtney D, ed. Academic Emergency Medicine. 2017;24(1):83-91. doi:10.1111/acem.13079
• Ba Y, Shi Y, Jiang W, et al. Current management of chemotherapy-induced neutropenia in adults: key points and new challenges. Cancer Biol Med. 2020;17(4):896-909. doi:10.20892/j.issn.2095-3941.2020.0069
• Thursky KA, Worth LJ. Can mortality of cancer patients with fever and neutropenia be improved? Current Opinion in Infectious Diseases. 2015;28(6):505-513. doi:10.1097/QCO.0000000000000202
• Al-Tawfiq JA, Hinedi K, Khairallah H, et al. Epidemiology and source of infection in patients with febrile neutropenia: A ten-year longitudinal study. J Infect Public Health. 2019;12(3):364-366. doi:10.1016/j.jiph.2018.12.006
• Kuo JC, De Silva M, Diwakarla C, et al. A Rapid Access Clinic to improve delivery of ambulatory care to cancer patients. Asia-Pacific Journal of Clinical Oncology. 2017;13(3):179-184. doi:10.1111/ajco.12641
• Baugh CW, Faridi MK, Mueller EL, et al. Near-universal hospitalization of US emergency department patients with cancer and febrile neutropenia. PLoS One. 2019;14(5):e0216835. doi:10.1371/journal.pone.0216835
• Kochanek M, Schalk E, von Bergwelt-Baildon M, et al. Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol. 2019;98(5):1051-1069. doi:10.1007/s00277-019-03622-0
• Jansma B, Vakkalanka P, Talan DA, et al. Guideline adherence for the management of emergency department patients with febrile neutropenia and no infection source: Is there room for improvement? Journal of Oncology Pharmacy Practice. Published online 2020. doi:10.1177/1078155219896396
• Taplitz RA, Kennedy EB, Bow EJ, et al. Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline Update. JCO. 2018;36(14):1443-1453. doi:10.1200/JCO.2017.77.6211
• Daniels LM, Durani U, Barreto JN, et al. Impact of time to antibiotic on hospital stay, intensive care unit admission, and mortality in febrile neutropenia. Support Care Cancer. 2019;27(11):4171-4177. doi:10.1007/s00520-019-04701-8
• Peyrony O, Gerlier C, Barla I, et al. Antibiotic prescribing and outcomes in cancer patients with febrile neutropenia in the emergency department. PLoS One. 2020;15(2):e0229828. doi:10.1371/journal.pone.0229828
• Mhaskar R, Clark OAC, Lyman G, et al. Colony-stimulating factors for chemotherapy-induced febrile neutropenia. Cochrane Database Syst Rev. 2014;(10):CD003039. doi:10.1002/14651858.CD003039.pub2
• Skoetz N, Bohlius J, Engert A, et al. Prophylactic antibiotics or G(M)-CSF for the prevention of infections and improvement of survival in cancer patients receiving myelotoxic chemotherapy. Cochrane Database Syst Rev. 2015;(12):CD007107. doi:10.1002/14651858.CD007107.pub3
• van der Velden WJFM, Blijlevens NMA, Feuth T, et al. Febrile mucositis in haematopoietic SCT recipients. Bone Marrow Transplant. 2009;43(1):55-60. doi:10.1038/bmt.2008.270
• Hatamabadi H, Arhami Dolatabadi A, Akhavan A, et al. Clinical Characteristics and Associated Factors of Mortality in Febrile Neutropenia Patients; a Cross Sectional Study. Arch Acad Emerg Med. 2019;7(1):39.
• Aagaard T, Reekie J, Jørgensen M, et al. Mortality and admission to intensive care units after febrile neutropenia in patients with cancer. Cancer Med. 2020;9(9):3033-3042. doi:10.1002/cam4.2955