Avaliação do perfil de atendimento de pacientes oncohematológicos admitidos com neutropenia febril no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro

Abstract

Febrile neutropenia (NF) is a common clinical emergency in oncohematological patients. Successful management of NF requires immediate recognition of the severity of the diagnosis. The guidelines point to the importance of carrying out rapid screening and risk stratification using validated criteria. However, there are still high rates of morbidity, mortality and costs related to this complication. Given this scenario, the present study aimed to describe the care profile of oncohematological patients admitted with febrile neutropenia at the Hospital de Clínicas of the Federal University of Triângulo Mineiro, a highly complex institution that provides specialized care for oncohematological patients in Uberaba and the region. Through analysis of medical records from 2018, involving 67 patients in 120 NF events and prospective analysis through clinical interviews, with 11 patients in 21 events, the aim was to outline the profile of medical care for oncohematological patients with NF treated. in this service, from pre-hospital care and looking for possible correlations between the patient's profile and the time taken to seek care, the approach adopted and the outcome. With regard to the variables possibly predictive of hospital discharge or death, there was no statistically significant difference between the groups in relation to the variables sex, age, education, origin, hematological parameters, use of granulocyte colony-stimulating factor, number of antibiotics and result of urine culture. However, it was noticed that there were a greater number of deaths in non-white patients, who required multiple antibiotics associated with antifungals, with peripheral oxygen desaturation, with the need to stay in an ICU bed and the presence of gram-negative bacteria. The analysis of the association of clinical and laboratory factors in the waiting time to seek care showed that sex, skin color, age group, origin, education level, blood pressure, heart rate, oxygen saturation, neutropenia and days of hospitalization were not associated with waiting time to seek medical care. Regarding clinical and laboratory parameters, it was observed that the longer waiting time was associated with the need for intensive therapy and the type of neoplasia, being greater in patients with lymphoma. In the prospective evaluation, it was observed that most patients reported that the initial care time, at the origin, took up to 30 minutes and that the transfer to the reference care was by their own means; that the transfer time to reach the reference service was less than six hours in 90% of the cases. In all cases, patients claimed to have received, at the reference service, information (written and verbal) about the course of action to take in case of fever. However, in almost half of the complications, the search for assistance occurred six hours after the onset of the fever. They also reported that more than three quarters received antibiotic therapy within an hour and were admitted to an isolation bed in the first half hour. Regarding the outcome, two deaths were recorded. The results obtained contributed to a better understanding of the disease and the diagnostic and therapeutic processes involved in NF, clarifying the most important causes of delay in treatment, which will allow the planning of actions that have a positive impact on the care of these patients.