Management of Febrile Neutropenia in Pediatric Oncology Across Queensland, Australia

Abstract

Febrile neutropenia (FN) is a common complication in pediatric oncology with intravenous antibiotics being given routinely for decades. This study aimed to compare the management of FN in children in different locations across Queensland, Australia. FN episodes were identified from 4 settings: tertiary oncology outpatient department (OD), tertiary emergency department (ED), regional ward (RW), and regional emergency department (RED) between July 2009 and June 2011. Retrospective data were extracted from medical records, collated, and then analyzed to identify differences in outcomes attributable to location. Sixty-one episodes of FN were reviewed: 5 cases from OD, 28 from ED, 19 from RW, and 5 from RED. Statistically significant differences occurred in the time taken for medical review for cases depending on location of presentation. Patients who presented to the ED or the RW were more likely to be seen within 30 minutes than in other locations ( P = .014), and patients who presented to the tertiary hospital in either the OD or ED were more likely to commence antibiotics within 120 minutes of presentation ( P = .023). Antibiotics were commenced within 60 minutes (the gold standard) on only 10 occasions. Despite education input emphasizing the importance of early commencement of antibiotics, this study identified that this objective was not met in the majority of cases. Further study is needed to look at reasons for the delay in beginning treatment for pediatric oncology patients in Queensland and what measures may assist with improving the time from presentation with FN to antibiotic administration across all settings.