Effectiveness of the "Golden Hour" program in preventing sepsis in pediatric patients with acute lymphoblastic leukemia.
In a retrospective cohort of pediatric patients with acute lymphoblastic leukemia, broad-spectrum antibiotic administration within 60 minutes of emergency-department triage was associated with a lower incidence of sepsis than administration after 60 minutes (22.7% versus 54.5%).
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In a retrospective cohort of pediatric patients with acute lymphoblastic leukemia, broad-spectrum antibiotic administration within 60 minutes of emergency-department triage was associated with a lower incidence of sepsis than administration after 60 minutes (22.7% versus 54.5%).
Research significance
Evidence: timely antibiotic administration was associated with less sepsis in this cohort. Inference: implementing a reliable Golden Hour pathway may reduce sepsis risk during febrile neutropenia in pediatric acute lymphoblastic leukemia, but causality and clinical benefit require confirmation in larger, prospectively controlled studies.
Source abstract
INTRODUCCIÓN: La iniciativa «Hora Dorada» se propone para reducir complicaciones graves en pacientes oncológicos pediátricos con neutropenia febril. Se refiere a la administración de antibiótico de amplio espectro en la primera hora de la atención en el servicio de urgencias. Los pacientes con leucemia linfoblástica aguda son de alto riesgo por la inmunosupresión prolongada. El objetivo fue determinar la administración de antibiótico dentro de los primeros 60 minutos como factor asociado a menor incidencia de sepsis en pacientes con leucemia linfoblástica aguda. MÉTODOS: Diseño de cohorte retrospectiva en expedientes de pacientes pediátricos con diagnóstico de leucemia linfoblástica aguda. Los grupos se integraron en función del tiempo de administración del antibiótico posterior al ingreso a triaje. En el grupo con administración oportuna (≤ 60 minutos) se estudiaron 44 pacientes y en el grupo con atención tardía (> 60 minutos), 11 pacientes. El diagnóstico de sepsis utilizó de referencia los criterios de Phoenix. El tiempo triaje-administración de antibiótico se midió en minutos. El análisis estadístico incluyó regresión logística simple y cálculo de probabilidad de ocurrencia del evento. RESULTADOS: El 54.5% del grupo con atención tardía desarrolló sepsis, en el grupo con atención oportuna la incidencia fue del 22.7% (p = 0.038). El modelo de regresión logística reportó significancia (p = 0.004). La probabilidad de desarrollar sepsis fue del 49.1% a los 80 minutos, el 35.5% a los 60 minutos y el 56% a los 90 minutos. CONCLUSIONES: La administración de antibiótico dentro de los primeros 60 minutos se asoció con menor incidencia de sepsis en pacientes con leucemia linfoblástica aguda. BACKGROUND: The “Golden Hour” initiative is intended to reduce serious complications in pediatric oncology patients with febrile neutropenia, and it refers to the administration of broad-spectrum antibiotics within the first hour of care in the emergency department. Patients with acute lymphoblastic leukemia are at high risk due to prolonged immunosuppression. The objective was to determine the administration of antibiotics within the first 60 minutes as a factor associated with a lower incidence of sepsis in patients with acute lymphoblastic leukemia. METHODS: Retrospective cohort design in the records of pediatric patients diagnosed with acute lymphoblastic leukemia, with groups organized based on the time of antibiotic administration after triage admission. In the timely administration group (≤ 60 minutes), 44 patients were studied, and in the delayed care group (> 60 minutes), 11 patients. The diagnosis of sepsis used the Phoenix criteria as a reference. The time between triage and antibiotic administration was measured in minutes. The statistical analysis included simple logistic regression and calculation of the probability of the event occurring. RESULTS: Fifty-four percent of the late-care group developed sepsis, while in the timely-care group the incidence was 22.7% (p = 0.038). The logistic regression model reported significance (p = 0.004). The probability of developing sepsis was 49.1% at 80 minutes, 35.5% at 60 minutes, and 56% at 90 minutes. CONCLUSIONS: Antibiotic administration within the first 60 minutes was associated with a lower incidence of sepsis in patients with acute lymphoblastic leukemia.