初探嗜中性白血球缺乏合併發燒癌童入院之等待處理時間

The Pilot Study of Admission Waiting Time for Cancer Children with Febrile Neutropenia

嗜中性白血球缺乏合併發燒是癌症治療中的緊急狀況，需儘快給予抗生素的使用，嗜中性白血球缺乏合併發燒癌童到院後，等待給予第一劑抗生素之時間越短，對生命的威脅性越小。本研究即為瞭解化療後嗜中性白血球缺乏合併發燒癌童入院等待處理之時間，以減少治療上的延遲所造成之嚴重後果。本研究於台灣北部某兒童醫院，民國94年8月至95年1月進行收案，收集22位因嗜中性白血球缺乏合併發燒38℃以上入院，且18歲以下癌症兒童資料，資料分析結果：癌童自家中發燒至求診之等待時間中位數為24小時，到院後等待醫師診查時間之中位數為45分鐘，其中14位經由急診入院，至急診等待醫生診查時間之中位數為57分鐘，另外8位病童經由門診住院，其至門診等候醫生診查時間之中位數為28分鐘；經急診入院之14位癌童，給予第一劑抗生素之中位數時間為入急診後132分鐘，經門診入院之8位癌童，給予第一劑抗生素之中位數時間為入門診後117分鐘。本研究結果之等候時間中位數，皆較Nirenberg、Mulhearn、Lin和Larson(2004)研究報告之時間短，且22位癌童中19位(86.4%)未在當次住院過程併發敗血症，顯示此兒童醫院之處理具時效性。而經由門診入院癌童之等待時間，較經急診入院者之等待時間短，可能因病童及家屬長期接受治療，和醫療團隊建立了信任關係，在出現發燒時，能很快和專業治療團隊聯繫，儘速至主治醫師門診尋求處置，爭取最大時效性。

Neutropenic fever is an emergency situation for cancer treatment and needs to take an administration of antibiotics as soon as possible. Therefore, the shorter waiting time, from the arrival of cancer children with febrile neutropenia to the initiation of antibiotics therapy, is vital. To reduce the life-threatening complications due to treatment delay, we investigated the admission waiting time and presented our findings. This study was performed at the children’s hospital in northern Taiwan from August 2005 to January 2006. Twenty-two cancer children younger than 18 years with a chief complaint of fever above 38 resulted from neutropenia were included. The median waiting time from the fever onset at home to the admission at the hospital was 24 hours. The median waiting time from admission to diagnosis made by a doctor was 45 minutes. Fourteen children admitted from the emergency department (ED) had 57 minutes median waiting diagnosis time, whereas eight children admitted from the outpatient department (OPD) had 28 minutes median waiting diagnosis time. To those ER children, the median waiting time from admission to initiation of antibiotics was 132 minutes, comparing to 117 minutes of that of OPD children. The median waiting time in this study was shorter than that of Nirenberg’s report in 2004, and most (86.4%, 19 of 22 visits) of the children did not develop sepsis or septic shock. The clinical survey indicated that the management of this hospital toward cancer children with febrile neutropenia was rapid and timely. Unexpectedly, the median waiting time for OPD admission was shorter than that of ED admission. We contributed the findings to a trust relationship among cancer children, caregivers and the oncology team. The caregivers realized the importance of admission in time and call for a help to the oncology team while cancer children have a fever.