title: Symptom to door interval in febrile neutropenia: perspective in India.
abstract: OBJECTIVE
  Febrile neutropenia (FN) is an oncological emergency to be treated within an hour. In a developing country, patients are often unable to reach hospital speedily. Our aim was to determine the symptom to door interval (SDI) in febrile neutropenic children with acute lymphoblastic leukaemia [ALL] and to identify factors resulting in delay.
  
  
  METHODS
  All consecutive children of ALL (< 14 years) presenting with FN over a period of 1 year were evaluated. Data for demographics, clinical details, phase of therapy, profile of caregivers, travelling time, SDI, reasons for delay, modes of transport, complications, invasive bacterial infections (IBI), length of hospital stay and outcome were recorded.
  
  
  RESULTS
  Among 320 FN episodes, median SDI (in hours) was 24 (IQR 8, 36). SDI during intensive phases was significantly less as compared to nonintensive phases 12 (IQR 6, 24) and 24 (IQR 24, 48) (p < 0.001). Children on induction phase reported to hospital at earliest [median 8 (IQR 4, 12)], while those on maintenance phase came late [median 36 (24, 48)]. Median travelling time was 15 min (IQR 15, 25) for patients on intensive phase and was 180 min (IQR 60, 285) for those on nonintensive phase (p< 0.001). Ingestion of acetaminophen at home (30 %), inability to realise the gravity of the situation (27 %), unawareness of parents (9 %) and nonavailability of transport (12 %) were the most common reasons for delay. No significant association of SDI was seen with complications, IBI, duration of hospital stay and mortality (p > 0.05).
  
  
  CONCLUSIONS
  Considerable time lag was seen between onset of symptoms and reaching hospital. Health education and establishment of shared care are urgent needs in countries where tertiary care facilities are limited.
authors.affiliation: Division of Pediatric Hematology-Oncology, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
authors.forename: Sapna
authors.initials: S
authors.lastname: Oberoi
authors.forename: Amita
authors.initials: A
authors.lastname: Trehan
authors.forename: R K
authors.initials: RK
authors.lastname: Marwaha
authors.forename: Deepak
authors.initials: D
authors.lastname: Bansal
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D058633:Antipyretics / Q000627:therapeutic use; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000209:etiology / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D007902:Length of Stay; D008297:Male; D009503:Neutropenia / Q000209:etiology / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D011446:Prospective Studies; D013997:Time Factors; D014187:Transportation of Patients
chemical_list: D058633:Antipyretics; D000082:Acetaminophen