RESULTS
During the period studied there were 134,335 visits to the PED. Among the 302 patients undergoing HCT followed-up during the 2-year period, 59 (19.5%) children, who received a total of 68 HCT sessions, had 213 care encounters in the PED (188 excluding nursing procedures), which represented 0.2% of all PED episodes. Demographic characteristics and clinical data are shown in Table 1. The median number of encounters per patient was 3 (interquartile range 2-4); 15 (25.4%) patients presented to the PED once, 32 (54.2%) visited twice, and 12 (20.3%) three or more times. Of the 188 episodes analyzed, 118 (62.8%) corresponded to patients who had received allogeneic HCT and 70 (37.2%) had undergone autologous HCT. Chief complaints in the PED visit were as follows: fever [with or without respiratory, digestive, otorhinolaryngologic (ORL), neurologic, cutaneous, osteoarticular, and urinary symptoms] in 74 (39.4%) patients, respiratory/ORL symptoms in 55 (29.2%), graft-versus-host disease complications in 49 (26.1%), and neurologic symptoms in 10 (5.3%).
Diagnostic tests were performed in 147 (78.2%) encounters: 100% (19) of those patients found to be unstable on PAT and 75.7% (128) with stable PAT (P value 0.02). In 93 (49.5%) episodes the children required treatment, 15 (78.9%) of whom were patients with unstable PAT and 78 (46.2%) with stable PAT (P value <0.001). The therapeutic interventions performed in these episodes were as follows: intravenous antibiotic therapy in 23 (24.7%), fluid bolus in 21 (22.6%), blood transfusion in 9 (9.7%), airway support in 3 (3.2%), and cardiovascular support in 2 (2.2%). According to the elapsed time between HCT and PED visit, diagnostic tests were performed in ≤100 days in 47 (79.7%) patients and in 95 (73.6%) >100 days (P value 0.37); in terms of those requiring treatment, 29 (49.2%) of these patients were children with ≤100 days since HCT and 52 (40.3%) in >100 days (P value 0.26). According to the HCT type, diagnostic tests were performed in 39 (76.5%) patients with allogeneic HCT and in 12 (70.6%) with autologous HCT (P value 0.63); 38 (74.6%) of patients with allogeneic HCT and 9 (53.0%) with autologous HCT (P value 0.07) required treatment.
Risk factors for admission are shown in Table 2.