Journal of pediatric hematology/oncology
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J. Pediatr. Hematol. Oncol. · May 2002
Modeling administrative outcomes in fever and neutropenia: clinical variables significantly influence length of stay and hospital charges.
Administrative outcomes such as length of stay and charges are used to compare the quality of care across institutions and among individual providers. Clinical variables representing disease severity may explain some of the variability in these outcomes. ⋯ The clinical variables that were significant in this study account, in validation R2 estimates, for more than 25% of the variability in administrative outcomes for encounters of fever and neutropenia. Adjusting length of stay and charges for these clinical variables would allow for a fairer comparison of institutions and individual providers. The electronic case-finding algorithm served as an efficient way to identify absolute monocyte count and tumor type as the major predictors and provided a conservative estimate of R2.
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J. Pediatr. Hematol. Oncol. · May 2002
Value of electronic data for model validation and refinement: bacteremia risk in children with fever and neutropenia.
Validating published risk models in a different time and setting can be a labor-intensive process. Data in electronic format provide the potential to test the validity of risk models without labor-intensive chart reviews and data capture. The authors attempted to use readily available electronic data to find appropriate cases and to validate and refine a previously developed risk model for predicting bacteremia in children with cancer who had fever and neutropenia. ⋯ Existing electronic data provide an efficient means for case-finding and model validation and refinement. The previously developed bacteremia model had good but not optimal predictive performance in the new data set. Admission absolute monocyte count and temperature remain significant risk factors for bacteremia. Redefining the risk categories, including a much lower cutpoint for admission absolute monocyte count, improved the model's discrimination, which suggests that predictive models need periodic updating.
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J. Pediatr. Hematol. Oncol. · May 2002
Case ReportsVertebral compression and eosinophilia in a child with acute lymphatic leukemia.
A 10-year-old girl, presenting with fever, eosinophilia, and back pain, was diagnosed with pre-B CD10-positive acute lymphoblastic leukemia. Eosinophilia resolved rapidly during remission induction treatment, but diffuse spinal osteopenia with multiple compression fractures became manifest after 4 weeks. ⋯ Eosinophilia and osteopenia are separately known as early manifestations of acute lymphoblastic leukemia, but their simultaneous occurrence is particularly interesting. A late bone marrow relapse was not accompanied by bone changes or eosinophilia.