Department of Pediatric Oncology/Hematology, University of Groningen, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands.
Department of Pediatric Oncology, Academic Medical Center, Emma Children's Hospital, Amsterdam, The Netherlands.
Pediatr Blood Cancer. 2019 Feb;66(2):e27504. doi: 10.1002/pbc.27504. Epub 2018 Oct 14.
Febrile neutropenia (FN) is a common complication of the intensive treatment strategies used in pediatric oncology. By close adherence to high-quality guidelines, which can be evaluated by indicators, the burden of FN can potentially be reduced.
The aims of this study were tripartite-(1) to develop structure, process, and outcome indicators, (2) to evaluate the implementation of the Dutch Childhood Oncology Group (DCOG) guideline on FN, and (3) to produce baseline measures on local quality of FN care (in the north of the Netherlands).
Seven indicators derived from the DCOG guideline were developed. Regarding structure indicators, we gathered information from all local centers providing care for children with cancer (n = 9). Regarding process and outcome indicators, we collected individual patient data from one academic and two shared-care hospitals. Children (<18 years) were included if they had been diagnosed with cancer in 2014 or 2015 and had suffered from FN.
Six out of nine hospitals used the DCOG guideline on FN and three hospitals used an outdated supportive care handbook. Regarding individual patient data, we included 119 FN episodes in 59 patients. All FN episodes without focus were initially treated with guideline-based antibiotics. Of all FN episodes, 18.5% resulted in intensive care unit (ICU) admittance. Cumulative incidence of death during FN was 1.74%.
Adherence to the DCOG guideline at the individual patient level was excellent. However, indicators concerning mortality and ICU admittances showed that FN still has devastating consequences. Subsequently, we will implement these indicators nationwide in order to improve FN care.
发热性中性粒细胞减少症（FN）是儿科肿瘤强化治疗策略的常见并发症。通过严格遵循高质量指南（可通过指标进行评估），FN 的负担可能会降低。
本研究旨在（1）制定结构、过程和结局指标，（2）评估荷兰儿科肿瘤学组（DCOG）FN 指南的实施情况，（3）提供荷兰北部 FN 护理质量的基线数据。
从 DCOG 指南中得出了 7 个指标。关于结构指标，我们从所有为癌症患儿提供治疗的本地中心（n=9）收集信息。关于过程和结局指标，我们从一家学术医院和两家共享护理医院收集了个别患者的数据。如果患儿（<18 岁）在 2014 年或 2015 年被诊断患有癌症且患有 FN，则将其纳入研究。
9 家医院中有 6 家使用了 DCOG 的 FN 指南，3 家医院使用了过时的支持性护理手册。在个别患者数据方面，我们纳入了 59 名患者的 119 例 FN 发作。所有无焦点的 FN 发作最初均采用基于指南的抗生素治疗。所有 FN 发作中，18.5%需要入住重症监护病房（ICU）。FN 期间的死亡率为 1.74%。
在个别患者层面上，对 DCOG 指南的依从性非常好。然而，死亡率和 ICU 入院率等指标表明 FN 仍有严重的后果。因此，我们将在全国范围内实施这些指标，以改善 FN 护理。
