6668 Management of paediatric oncology patients presenting with a fever in a POSCU

Objectives The management of paediatric oncology patients presenting with a fever comprises a large part of emergency presentations at paediatric oncology shared care units (POSCUs). Children's Cancer and Leukaemia Group (CCLG) guidance changed in 2020 to recommend patients could be discharged after a shorter period of observation if classified as low risk to safely reduce admissions and IV antibiotic administration.¹ This guidance was incorporated into our guideline. This audit was undertaken to determine how oncology patients presenting with fever were investigated and managed over a 3 month period. Methods Patient records were prospectively collected for oncology patients presenting between March and June 2023. These were reviewed and patients who presented without a fever were excluded. Records of remaining eligible patients were reviewed to ascertain their investigation and management. Results There were 22 presentations; 2 were neutropenic and 20 were non-neutropenic. In 17/22 (77%) all locally recommended investigations were taken (FBC, U&Es, CRP, LFTs, bone profile, blood cultures and urine culture in <5y). IV antibiotics were administered within 1 hour in 36% of cases; this increased to 61% when presentations with unclear documentation were excluded. 14/22 (64%) had a positive investigation result – most commonly NPA (8) followed by blood culture (5). 1 of the 2 neutropenic patients was eligible for the low risk protocol and discharged appropriately on oral antibiotics leading to a decreased length of stay (LOS) of 1 day, compared to 2 days for the other. Non-neutropenic patients had a mean LOS of 2.8 days (1–10 days range). Patients with LOS >5d had confirmed infections (EBV/adenovirus/line sepsis), but it was not clearly documented why patients with LOS of 2–3 days were admitted and whether they could have been discharged sooner. Conclusion Our results reflect that most paediatric oncology patients presenting with fever are non-neutropenic. However, they are assessed and managed using the same proforma for neutropenic children to ensure early assessment, investigation and administration of IV antibiotics. We recommended the proforma be updated to give clearer recommendations for management once the FBC is resulted; if non-neutropenic and clinically well they can follow the non-neutropenic pathway which may result in more prompt discharge and a better patient experience. The number of patients receiving IV antibiotics within 1 hour was low and hence it was recommended to identify and address barriers to this and improve documentation of arrival and when antibiotics were given. Reference Managing febrile neutropenia in the UK in 2020 proposed new management pathway, Children's Cancer and Leukaemia Group, 2022.