Infectious Disease and Supportive Care Outcomes in Adult Oncology Patients

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-08-16 DOI:10.1016/j.jemermed.2025.04.036

Sidharth Iyer BS , Jason J Bischof MD

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引用次数: 0

Abstract

Background

Patients with cancer on immunosuppressive drugs face an increased risk for serious bacterial infections and commonly present to the emergency department (ED) with bacterial bloodstream infections (BSIs), making prompt administration of antibiotics critical. However, for ED oncology patients presenting with fever in the absence of neutropenia, there is limited data to guide their management. To address this gap in care, the Esbenshade model was developed to stratify BSI risk in febrile non-neutropenic pediatric oncology patients. In this study, we aimed to evaluate whether this model retains its predictive accuracy in an adult population.

Methods

This retrospective single site chart review analyzed adult oncology patients presenting to an urban, academic ED in the Midwest affiliated with a Comprehensive Cancer Center. Inclusion criteria encompassed patients diagnosed with malignancy and presenting with non-neutropenic fever. Patients with a history of remote cancer or without fever within 24 hours of presentation were excluded. Retrospective chart review data was collected using the Esbenshade (EsVan2b) model variables and were analyzed using descriptive statistics, and sensitivity and specificity calculations to evaluate the model's predictive accuracy.

Results

284 patients met the inclusion criteria. The median patient age was 63 years, with 58% being male and 81% identifying as white. Blood cultures were positive in 66 out of the 284 febrile episodes (BSI rate = 23%). The Esbenshade model in an adult population demonstrated a sensitivity of 0% and a specificity of 98%, and an AUC of 0.680.

Conclusion

The retrospective data demonstrate that the EsVan2b model performed poorly in predicting BSI risk in adult cancer patients presenting with non-neutropenic fever. This suggests that the model may not be suitable for use in the adult population and highlights the need for further research to develop or adapt predictive tools for this demographic.

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成人肿瘤患者的传染病和支持性治疗结果

使用免疫抑制药物的癌症患者面临严重细菌感染的风险增加，并且通常以细菌性血流感染（bsi）出现在急诊科（ED），因此及时给予抗生素至关重要。然而，对于没有中性粒细胞减少症的ED肿瘤患者，有有限的数据来指导他们的治疗。为了解决护理方面的这一差距，我们开发了Esbenshade模型，对发热性非中性粒细胞减少的儿科肿瘤患者的BSI风险进行分层。在这项研究中，我们旨在评估该模型是否在成年人群中保持其预测准确性。方法：本回顾性单点图表分析了在中西部城市学术急诊科就诊的成人肿瘤患者，该急诊科隶属于一家综合癌症中心。纳入标准包括诊断为恶性肿瘤并表现为非中性粒细胞减少热的患者。排除有远处癌症病史或发病24小时内无发热的患者。使用Esbenshade （EsVan2b）模型变量收集回顾性图表回顾数据，并使用描述性统计、敏感性和特异性计算进行分析，以评估模型的预测准确性。结果284例患者符合纳入标准。患者年龄中位数为63岁，58%为男性，81%为白人。284例发热发作中66例血培养阳性（BSI率 = 23%）。Esbenshade模型在成年人群中的敏感性为0%，特异性为98%，AUC为0.680。结论回顾性数据表明，EsVan2b模型在预测非中性粒细胞减少热的成年癌症患者BSI风险方面表现不佳。这表明，该模型可能不适合在成人人群中使用，并强调需要进一步研究，以开发或适应这一人口统计的预测工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine