Time to Antibiotic for Pediatric Oncology Patients With Febrile Neutropenia at Regional Emergency Departments.

OBJECTIVES We compared the time to antibiotic (TTA) for pediatric oncology patients with febrile neutropenia (FN) presenting at regional emergency departments (EDs) with those presenting at a pediatric referral ED, and examined its association with need for aggressive medical care. METHODS We abstracted data for pediatric oncology patients (age, 60 minutes) were estimated using generalized linear modeling with generalized estimating equations (GEEs). Delay in antibiotic administration was examined for its association with the need for aggressive medical care (>1 fluid bolus, intensive care unit admission, inotropic or invasive ventilator support) within 24 hours of admission as an exploratory aim. RESULTS Three-hundred eighty-nine FN admissions (regional ED, 26.7%; referral ED, 73.3%) occurred in 205 eligible patients. Median TTA was significantly (P < 0.0001) greater among patients presenting at a regional ED (117.5 minutes [range, 9-722 minutes]) vs referral ED (46 minutes [range, 6-378 minutes]). Presentation at regional ED was the only factor associated with delay in antibiotic administration (odds ratio, 9.73; 95% confidence interval, 5.37-17.63; P < 0.0001). Delay in antibiotic administration was not associated with greater need for aggressive medical care (odds ratio, 1.34; 95% confidence interval, 0.55-3.29; P = 0.5). CONCLUSIONS Pediatric oncology patients with FN presenting to regional EDs have longer TTA as compared with those presenting to a referral ED at a children's hospital.