Emergency department disposition of non-neutropenic febrile patients with cancer.
Emergency department disposition of non-neutropenic febrile patients with cancer.
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DOI：
10.1002/emp2.12576
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发表时间：
2021-10
影响因子：
2.3
通讯作者：
Caterino JM
中科院分区：
文献类型：
--
作者：
Bischof JJ;Sylvester PJ;Frey JA;Stephens JA;Hammond B;Garmatter J;Hebert C;Caterino JM
国家数据显示，癌症患者每年450万次急诊（艾德）就诊中有60%导致入院。许多这些访问是由于发热性疾病。目前的文献对如何治疗非血小板减少性发热艾德患者提供的指导有限。本研究描述了在学术性综合癌症中心附属ED就诊的非血小板减少性发热癌症患者的临床结局。回顾性病历审查了2015年10月至2016年9月期间在艾德以发热或记录发热为主诉且中性粒细胞绝对计数高于1000的101例随机选择的活动性癌症成人患者。计算描述性统计量。主要恶性肿瘤包括血液系统（24%）、胃肠道（13%）、头颈部（13%）和泌尿生殖系统（8%）。62%的患者接受化疗，15%接受放射治疗，12%接受靶向治疗。39%的患者发生严重疾病结局，83%的患者入院，中位住院时间为4天。在住院患者中，24%的患者住院时间≤2天。10%的患者在首次访视后7天内回访艾德或系统内住院，4%的患者在首次访视后7天内死亡。大多数因非血小板减少性发热就诊于艾德的患者（83%）入院，其中近四分之一的患者住院时间≤2天，严重疾病结局罕见。未来的工作重点应放在开发这一人群的风险分层工具，以避免潜在的不必要的住院治疗。
National data reveal that 60% of the 4.5 million annual emergency department (ED) visits by patients with cancer result in admission. Many of these visits are due to a febrile illness. Current literature provides limited guidance on how to treat non‐neutropenic febrile ED patients. This study characterizes clinical outcomes of non‐neutropenic febrile patients with cancer presenting to an academic, Comprehensive Cancer Center affiliated ED. Retrospective chart review of 101 randomly selected adult patients with active cancer presenting with a chief complaint of fever or a documented fever in the ED and an absolute neutrophil count above 1000 between October 2015 and September 2016. Descriptive statistics were calculated. The primary malignancies represented were hematologic (24%), gastrointestinal (13%), head and neck (13%), and genitourinary (8%). Sixty‐two percent were on chemotherapy, 15% on radiation therapy, and 12% were on targeted therapy. Severe illness outcomes occurred in 39% and 83% were admitted with a median length of stay of 4 days. Among admitted patients, 24% experienced a length of stay ≤2 days. A return visit to the ED or an in‐system hospitalization within 7 days of the index visit occurred in 10% and death occurred within 7 days of the index visit in 4%. A majority of patients presenting to the ED with non‐neutropenic fever are admitted (83%), of whom nearly a quarter experience a length of stay of ≤2 days with infrequent serious illness outcomes. Future efforts should focus on the development of risk stratification tools in this population to avoid potentially unnecessary hospitalizations.
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