[Granulocytopenia and fever in children with leukemia as indicator of quality of medical care].
OBJECTIVE
1. To identify the quality degree of medical care in patients with acute leukaemia who had fever and granulocytopenia during the hospitalization period. 2. To establish the relationship between the medical care process and the results in this concern.


METHODS
Retrospective survey.


METHODS
Children's Hospital of the Mexican Institute of Social Security.


METHODS
Twenty three patients with acute leukaemia were studied. Also, hospitalization episode of these patients, in which they suffered fever and granulocytopenia, was randomly selected.


METHODS
Compliance of diagnostic and therapeutic process was measured during hospitalization, according to the protocolized recommendations made by consensus of the hospital expert group. In order to identify the quality degree of medical care, it was taken into account the protocol compliance besides the results observed in the patients. Results were assessed based on patients' survival to fever and granulocytopenia episode, as well as on fever's duration. The correlation was calculated by using Spearman's coefficient.


RESULTS
The medical care quality of the hospital was "adequate" (85% on average). Compliance degree, including the total process was 71%; with diagnostic process 63%, and with therapeutic process 76%. The results observed in the patients were considered as "adequate" (89%). By evaluating individual cases, the medical care quality was considered excellent or adequate in 17 patients (74%) regular in five (22%) and poor in one (4%). Diagnostic process was adequate in 6 patients (26%) regular in 12 (53%) poor in three (13%) and very bad in two (8%). On the other hand, therapeutic process was excellent in 14 patients (60%) regular in one (4%) poor in six (26%) and very bad in two (9%). Results observed in 13 cases were excellent (57%) adequate in eight (35%) regular in one (4%) and very bad in one (4%). The relationship between process and result was 0.41 (P < 0.05) between diagnostic process and result 0.14 and, between therapeutic process and result 0.34.


CONCLUSIONS
The medical care quality rendered to patients with leukaemia, who suffered a granulocytopenia episode and fever, was considered as adequate. Therapeutic recommendations were followed accurately, meanwhile, diagnostic process had a lower adherence. A positive relationship between process and result was observed.
Hospital de Pediatría, Unidad de Investigación en Epidemiología Clínica, México, D.F.
E E
EE
Delgado-González
J
J
Garduño-Espinosa
M C
MC
Martínez-García
R
R
Dávila-Martínez
H
H
Benítez-Aranda
J A
JA
Trejo-Pérez
O
O
Muñoz-Hernández
D000293:Adolescent; D000380:Agranulocytosis / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000150:complications / Q000628:therapy*; D008297:Male; D011787:Quality of Health Care; D011897:Random Allocation; D012189:Retrospective Studies
Granulocitopenia y fiebre en niños con leucemia como indicador de calidad de la atención médica.