title: A comparison of discharge strategies after chemotherapy completion in pediatric patients with acute myeloid leukemia: a report from the Children's Oncology Group.
abstract: While most children receive acute myeloid leukemia (AML) chemotherapy as inpatients, there is variability in timing of discharge after chemotherapy completion. This study compared treatment-related morbidity, mortality and cumulative hospitalization in children with AML who were discharged after chemotherapy completion (early discharge) and those who remained hospitalized. Chart abstraction data for 153 early discharge-eligible patients enrolled on a Children's Oncology Group trial were compared by discharge strategy. Targeted toxicities included viridans group streptococcal (VGS) bacteremia, hypoxia and hypotension. Early discharge occurred in 11% of courses post-Induction I. Re-admission occurred in 80-100%, but median hospital stay was 7 days shorter. Patients discharged early had higher rates of VGS (adjusted risk ratio (aRR) = 1.67, 95% CI = 1.11-2.51), hypoxia (aRR = 1.92, 95% CI = 1.06-3.48) and hypotension (aRR = 4.36, 95% CI = 2.01-9.46), but there was no difference in mortality. As pressure increases to shorten hospitalizations, these results have important implications for determining discharge practices in pediatric AML.
authors.affiliation: a Division of Oncology ;
authors.forename: Tamara P
authors.initials: TP
authors.lastname: Miller
authors.affiliation: a Division of Oncology ;|b Center for Pediatric Clinical Effectiveness , The Children's Hospital of Philadelphia , Philadelphia , PA , USA ;
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Getz
authors.affiliation: a Division of Oncology ;
authors.forename: Marko
authors.initials: M
authors.lastname: Kavcic
authors.affiliation: a Division of Oncology ;|c Center for Clinical Epidemiology and Biostatistics , University of Pennsylvania School of Medicine , Philadelphia , PA , USA ;
authors.forename: Yimei
authors.initials: Y
authors.lastname: Li
authors.affiliation: b Center for Pediatric Clinical Effectiveness , The Children's Hospital of Philadelphia , Philadelphia , PA , USA ;
authors.forename: Yuan-Shun V
authors.initials: YS
authors.lastname: Huang
authors.affiliation: d Department of Haematology/Oncology , The Hospital for Sick Children , Toronto , Canada ;
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
authors.affiliation: e Department of Preventative Medicine , University of Southern California , Arcadia , CA , USA ;|f Children's Oncology Group , Monrovia , CA , USA ;
authors.forename: Todd A
authors.initials: TA
authors.lastname: Alonzo
authors.affiliation: f Children's Oncology Group , Monrovia , CA , USA ;
authors.forename: Robert
authors.initials: R
authors.lastname: Gerbing
authors.affiliation: g Department of Pediatrics , Children's Healthcare of Atlanta , Atlanta , GA , USA ;
authors.forename: Marla
authors.initials: M
authors.lastname: Daves
authors.affiliation: h Department of Pediatrics , Section of Hematology-Oncology, Texas Children's Hospital , Houston , TX , USA ;
authors.forename: Terzah M
authors.initials: TM
authors.lastname: Horton
authors.affiliation: i Hematology Division , University of Utah School of Medicine , Salt Lake City , UT , USA ;
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pulsipher
authors.affiliation: j Cancer and Blood Disorders Center , Seattle Children's Hospital , Seattle , WA , USA ;
authors.forename: Jessica
authors.initials: J
authors.lastname: Pollard
authors.affiliation: a Division of Oncology ;|k Departments of Pediatrics , University of Pennsylvania School of Medicine , Philadelphia , PA , USA ;
authors.forename: Rochelle
authors.initials: R
authors.lastname: Bagatell
authors.affiliation: a Division of Oncology ;|k Departments of Pediatrics , University of Pennsylvania School of Medicine , Philadelphia , PA , USA ;
authors.forename: Alix E
authors.initials: AE
authors.lastname: Seif
authors.affiliation: b Center for Pediatric Clinical Effectiveness , The Children's Hospital of Philadelphia , Philadelphia , PA , USA ;|c Center for Clinical Epidemiology and Biostatistics , University of Pennsylvania School of Medicine , Philadelphia , PA , USA ;|k Departments of Pediatrics , University of Pennsylvania School of Medicine , Philadelphia , PA , USA ;|l Infectious Diseases , The Children's Hospital of Philadelphia , Philadelphia , PA , USA ;
authors.forename: Brian T
authors.initials: BT
authors.lastname: Fisher
authors.affiliation: m Pediatric Hematology/Oncology , Children's Mercy Hospital , Kansas City , MO , USA.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Gamis
authors.affiliation: a Division of Oncology ;|c Center for Clinical Epidemiology and Biostatistics , University of Pennsylvania School of Medicine , Philadelphia , PA , USA ;|k Departments of Pediatrics , University of Pennsylvania School of Medicine , Philadelphia , PA , USA ;|l Infectious Diseases , The Children's Hospital of Philadelphia , Philadelphia , PA , USA ;
authors.forename: Richard
authors.initials: R
authors.lastname: Aplenc
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D009026:Mortality; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission; D012189:Retrospective Studies
keywords: Pediatrics; acute myeloid leukemia; morbidity; patient discharge