Outcomes of Hospitalized Hematologic Oncology Patients Receiving Rapid Response Team Activation for Acute Deterioration
CCCF ePoster library. Gershkovich B. Nov 8, 2018; 233420; 50
Dr. Benjamin Gershkovich
Dr. Benjamin Gershkovich
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Background: Patients with hematologic malignancies who are admitted to hospital are at increased risk of developing disease or treatment-associated toxicities, inducing critical illness and potentially death. Rapid Response Teams (RRTs) respond to hospitalized patients who clinically deteriorate and assist with their management. Little is known regarding short-term outcomes following RRT activation in this population.  


Objectives: We sought to identify characteristics and outcomes of hematologic oncology inpatients following RRT activation for acute deterioration.


Methods: We used prospectively collected registry data from two hospitals within The Ottawa Hospital network, between 2012-2016. Consecutive hematologic oncology inpatients who experienced acute deterioration resulting in activation of the RRT were included in the study. Data was gathered at the time of RRT activation and assessment. Patients were followed to the point of death or hospital discharge. The primary outcome was in-hospital mortality.


Results: 399 hematologic oncology inpatients were included in the study, of which 120 (30.0%) had received Hematopoietic Cell Transplant (HCT). Mean age of patients was 61.6 years (SD 15.3), and 254 (63.3%) were male. The most common underlying malignancies were non-Hodgkin lymphoma (n = 120, 30.0%), acute myeloid leukemia (n = 102, 25.6%), and multiple myeloma (n = 60, 15.0%). 245 patients (61.4%) were receiving active treatment for their malignancy during their hospitalization, and 154 (38.6%) were neutropenic at the time of RRT assessment. Of the HCT patients, 59 (49.1%) were autograft recipients, while the remaining 61 (50.8%) were allograft recipients. Mean Elixhauser Comorbidity Index was 9.6 (SD 8.2) The most common reasons for activation of the RRT were acute respiratory distress (n = 124, 30.9%), tachycardia (n = 68, 17.0%), and hypotension (n = 58, 14.5%). 145 patients (45%) were admitted to ICU following RRT assessment. In-hospital mortality for all hematologic oncology patients following acute deterioration and RRT activation was 42.1%. For HCT patients, rates of ICU admission and in-hospital mortality were 41.7% and 36.6%, respectively. Mortality among autograft recipients was 28.8%, and among allograft recipients was 44.3% (P = 0.07).


Conclusions: Malignant hematology inpatients experience high rates of ICU admission and death following acute deterioration and activation of the RRT. More prospective data is required to inform shared decision-making around goals of care in this patient population.


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