18 - Time to Antibiotic Administration for Pediatric Oncology Patients: A Retrospective Study in a Tertiary Care Children's Hospital

It is established that early administration of antibiotics in the emergency department results in better outcomes for patients, with 57% shorter hospital stays and 59% shorter ICU stays. The majority of pediatric oncology patients have existing central venous lines (CVL). Therefore accessing the CVL by trained personnel would be important for timely blood draw and antibiotic administration. There is a lack of sufficient data on CVL access time in oncology patients who present with sepsis. We therefore analyze the length of time that elapses from triage to CVL access in oncology patients.

Objective:

To study the impact of various patient and ER factors on the sepsis intervention timeline in pediatric oncology patients.

Design/Methods:

We conducted a retrospective study of children less than 18 years old with diagnosis of oncologic disease and presented to our ER with sepsis from 2016 to 2021. We collected demographic and clinical data, data related to key sepsis management interventions including time stamps and data related to patient outcomes. We analyzed the data using the two-sample t-test, and linear and logistic regression.

Results:

Out of 189 eligible patients, 61% were male, 81% were Hispanic, median age 8 years old, and 65% had ALL. In the ER, the antibiotic delivery time was not affected by order entry time (R² < 0.01) but was affected by vascular access time (R² = 0.49). To further investigate factors that impact vascular access time, we found that the vascular access time was not affected by factors such as the age of the patient (R² < 0.01), clinical appearance (p > 0.05), day of the week (p > 0.05), or time of day (p > 0.05).

The median vascular access time was 83 minutes, and the median antibiotic delivery time was 104 minutes. In our study, the antibiotic delivery time actually did not significantly affect length of stay (R² < 0.01), ICU stay (p > 0.05), or the incidence of multi-organ dysfunction (p > 0.05). Stage of cancer treatment did have an impact on patient outcome. Those still receiving treatment had average length of stay 8.2 days (CI, 5.94 to 10.5), compared to those on maintenance or in remission at 3.9 days (CI, 2.49 to 5.31).

Conclusion(s):

Despite existing vascular access, the median time to antibiotic administration was longer than the recommended sepsis guidelines of 60 minutes. Patient age, appearance, time of day, and time of week had no significant effect on vascular access or on antibiotic delivery time. Further investigation will be done to elucidate causes of delay in treatment, such as the type of existing vascular access and ER staffing during patient visits.