Early hospital discharge followed by outpatient management versus continued hospitalization of children with cancer, fever, and neutropenia at low risk for invasive bacterial infection.
OBJECTIVE
To compare outcome and cost of ambulatory versus hospitalized management among febrile neutropenic children at low risk for invasive bacterial infection (IBI).


METHODS
Children presenting with febrile neutropenia at six hospitals in Santiago, Chile, were categorized as high or low risk for IBI. Low-risk children were randomly assigned after 24 to 36 hours of hospitalization to receive ambulatory or hospitalized treatment and monitored until episode resolution. Outcome and cost were determined for each episode and compared between both groups using predefined definitions and questionnaires.


RESULTS
A total of 161 (41%) of 390 febrile neutropenic episodes evaluated from June 2000 to February 2003 were classified as low risk, of which 149 were randomly assigned to ambulatory (n = 78) or hospital-based (n = 71) treatment. In both groups, mean age (ambulatory management, 55 months; hospital-based management, 66 months), sex, and type of cancer were similar. Outcome was favorable in 74 (95%) of 78 ambulatory-treated children and 67 (94%) of 71 hospital-treated children (P = NS). Mean cost of an episode was US 638 dollars (95% CI, 572 dollars to 703 dollars) and US 903 dollars (95% CI, 781 dollars to 1,025 dollars) for the ambulatory and hospital-based groups, respectively (P =.003).


CONCLUSIONS
For children with febrile neutropenia at low risk for IBI, ambulatory management is safe and significantly cost saving compared with standard hospitalized therapy.
Santolaya
María E
ME
Department of Pediatrics, University of Chile, Los Huasos 1948, Las Condes, Santiago, Chile. msantola@med.uchile.cl
Alvarez
Ana M
AM
Avilés
Carmen L
CL
Becker
Ana
A
Cofré
José
J
Cumsille
Miguel A
MA
O'Ryan
Miguel L
ML
Payá
Ernesto
E
Salgado
Carmen
C
Silva
Pamela
P
Tordecilla
Juan
J
Varas
Mónica
M
Villarroel
Milena
M
Viviani
Tamara
T
Zubieta
Marcela
M
D000553:Ambulatory Care; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001424:Bacterial Infections / Q000209:etiology* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D005260:Female; D005334:Fever / Q000139:chemically induced* / Q000191:economics / Q000628:therapy*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D009369:Neoplasms / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced* / Q000191:economics / Q000628:therapy*; D010351:Patient Discharge; D012307:Risk Factors; D016896:Treatment Outcome