Abstract
Background
Pediatric oncology patients may be at a higher risk of complications and mortality
from sepsis compared with their nononcology counterpart.
Objectives
The aim of this study is to compare characteristics, treatment, and sepsis-related
mortality between oncology and nononcology patients presenting to the emergency department
(ED).
Methods
This is a retrospective single-center cohort study including patients <18 years old
with a diagnosis of sepsis, severe sepsis, septic shock, or bacteremia presenting
to an academic ED between January 2009 and January 2015. A total of 158 patients were
included with 53.8% having an underlying malignancy. The primary outcome of the study
was in-hospital mortality. Secondary outcomes included ED vital signs, resuscitation
parameters, laboratory work, infection site, general practitioner unit, intensive
care unit length of stay, and hospital length of stay.
Results
Oncology patients had a higher in-hospital mortality (5.9% vs. 2.7%), however, it
did not meet statistical significance (p = 0.45). On presentation, oncology patients had a lower respiratory rate (24.33 ± 9.48
vs. 27.45 ± 7.88; p = 0.04). There was a significant increase in the white blood count in oncology patients
(4.011 ± 4.965 vs. 17.092 ± 12.806; p < 0.001) with this cohort receiving more intravenous fluids. In the first 6 hours
(33.0 ± 27.7 mL/kg vs. 24.9 ± 16.1 mL/kg; p = 0.029) as well as having a higher percentage of vasopressor administration (15.3%
vs. 1.4%; p = 0.002). Antibiotics were initiated at an earlier stage in the oncology cohort (1.25 ± 1.95
vs. 3.33 ± 1.97 hours; p < 0.0001). Cancer-free patients had a significantly higher rate of lung infections
compared with cancer patients (68.5% vs. 32.9%; p < 0.0001). In terms of infection characteristics, cancer patients had a higher percentage
of bacteremia (27.1% vs. 4.1%; p < 0.001).
Conclusion
There was no statistical significance regarding mortality between the 2 cohorts. Pediatric
cancer patients were found to have a higher incidence of bacteremia and received more
aggressive treatment.
Keywords
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Article info
Publication history
Published online: June 19, 2019
Accepted:
April 9,
2019
Received in revised form:
March 28,
2019
Received:
November 9,
2018
Footnotes
Reprints are not available from the authors.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
