DISCUSSION
Only 20% of HCT patients followed-up in this study presented to the PED. These individuals tended to visit the PED more than 100 days after HCT, and fever was their main complaint. Despite having a stable PAT, most of these patients required diagnostic and therapeutic interventions.
As in other articles7, 8, 9, fever was the leading cause of PED presentation, accounting for 1 out of every 3 care episodes. The median age of HCT patients was higher than the rest of the patients receiving care in the PED. Leukemia was the most common oncohematological disease, thus coinciding with other patient series10, 11. The most prevalent HCT type in our series was haploidentical allogeneic and the median time from HCT until PED presentation was more than 100 days in agreement with the existing literature10.
Although the HCT patients in our cohort represented a small percentage of the overall PED visits, the care they required placed a high burden on staff, as the children spent more time on average in the PED and required numerous diagnostic and therapeutic interventions. This was even more the case for patients who had an unstable PAT assessment upon arrival to the PED.
The admission rate for HCT patients was six times higher than the overall rate, though no correlation was found between admission and HCT type. Unstable PAT and ≤100 days from HCT to PED presentation were the main risk factors for admission in these patients, raising the likelihood of PED presentation to three times and twice the risk, respectively, of stable patients and those for whom >100 days had elapsed since HCT. Unplanned return visits8were above what is recommended in a PED12, possibly owing to the fact that the oncologic day hospital was only open on weekdays. In contrast, the admission rate for the second visit was below the established limit8, which suggests that these patients were correctly cared for in the PED.
Our study has several limitations, starting with the retrospective, single-center design used. Second, many patients with a history of HCT are from outside the region of Madrid and may have returned to their place of residence after 3 months post-transplantation, which means that some may not be represented in the registry, as only the most severe patients are likely to remain nearby for care after transplantation. Despite these limitations, we believe the data used in this study faithfully represent our HCT patients.
Despite representing a minimal percentage of visits to the PED, HCT-patient care posed a significant care burden due to the very significant number of care encounters required, complementary tests administered, and the treatments performed. Establishing an independent PED care circuit that provides care on both weekends and weekdays would benefit these patients. According to our data, the need for admission was more accurately predicted by altered states according to the PAT system and the days since transplantation than the HCT type.