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.