ArticlePloS one2012
Low socioeconomic status is associated with prolonged times to assessment and treatment, sepsis and infectious death in pediatric fever in El Salvador.
Article in PloS one, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 5 of them syntheses that pooled it.
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Who cites it
24 citing papers in PubMed, 5 syntheses or guidelines pooled it, 67 citations in OpenAlex.
- Association of Time to Antibiotics With Outcome in Pediatric Patients Receiving Chemotherapy for Cancer With Fever in Neutropenia-An International Individual Patient Data Meta-Analysis.Cancer medicine · 2026Pooled it
- Determinants of delayed childhood cancer care in low- and middle-income countries: A systematic review.Pediatric blood & cancer · 2023Pooled it
- Association of time to antibiotics and clinical outcomes in patients with fever and neutropenia during chemotherapy for cancer: a systematic review.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2020Pooled it
- A systematic review of associations between non-communicable diseases and socioeconomic status within low- and lower-middle-income countries.Journal of global health · 2018Pooled it
- The under reporting of recruitment strategies in research with children with life-threatening illnesses: A systematic review.Palliative medicine · 2017Pooled it
- Association Between Community-Level Social Determinants of Health and Sepsis Incidence and Mortality: A Scoping Review.Critical care explorations · 2026Article
- Process Analysis of Time to Antibiotics in Pediatric Patients With Fever in Neutropenia During Chemotherapy for Cancer.Journal of pediatric hematology/oncology · 2026Article
- Ewing sarcoma of the thumb presenting in a Hispanic patient: A case report.International journal of surgery case reports · 2024Article
- A di-electrophoretic simulation procedure of iron-oxide micro-particle drug attachment system for leukemia treatment using COMSOL software: a potential treatment reference for LMICs.Frontiers in medical technology · 2023Article
- Storytelling workshop to encourage stakeholder engagement with the Global Initiative for Childhood Cancer.Revista panamericana de salud publica = Pan American journal of public health · 2023Article
- A multimodal strategy to improve health care for pediatric patients with cancer and fever in Peru.Revista panamericana de salud publica = Pan American journal of public health · 2023Article
- Time to antibiotics is unrelated to outcome in pediatric patients with fever in neutropenia presenting without severe disease during chemotherapy for cancer.Scientific reports · 2022Article
- Challenges and Solutions in translating sepsis guidelines into practice in resource-limited settings.Translational pediatrics · 2021Review
- The Golden Hour: Sustainability and Clinical Outcomes of Adequate Time to Antibiotic Administration in Children with Cancer and Febrile Neutropenia in Northwestern Mexico.JCO global oncology · 2021Observational
- A Pediatric Sepsis Protocol Reduced Mortality and Dysfunctions in a Brazilian Public Hospital.Frontiers in pediatrics · 2021Article
- Delayed Presentation and Mortality in Children With Sepsis in a Public Tertiary Care Hospital in Tanzania.Frontiers in pediatrics · 2021Article
- Article
- Protocol for a systematic review of time to antibiotics (TTA) in patients with fever and neutropenia during chemotherapy for cancer (FN) and interventions aiming to reduce TTA.Systematic reviews · 2019Article
- The global burden of sepsis: barriers and potential solutions.Critical care (London, England) · 2018Review
- Management of fever and neutropenia in children with cancer.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2015Article
Corrections and comments
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Authors and funding
9 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundInfection remains the most common cause of death from toxicity in children with cancer in low- and middle-income countries. Rapid administration of antibiotics when fever develops can prevent progression to sepsis and shock, and serves as an important indicator of the quality of care in children with acute lymphoblastic leukemia and acute myeloid leukemia. We analyzed factors associated with (1) Longer times from fever onset to hospital presentation/antibiotic treatment and (2) Sepsis and infection-related mortality.
methodThis prospective cohort study included children aged 0-16 years with newly diagnosed acute leukemia treated at Benjamin Bloom Hospital, San Salvador. We interviewed parents/caregivers within one month of diagnosis and at the onset of each new febrile episode. Times from initial fever to first antibiotic administration and occurrence of sepsis and infection-related mortality were documented.
findingsOf 251 children enrolled, 215 had acute lymphoblastic leukemia (85.7%). Among 269 outpatient febrile episodes, median times from fever to deciding to seek medical care was 10.0 hours (interquartile range [IQR] 5.0-20.0), and from decision to seek care to first hospital visit was 1.8 hours (IQR 1.0-3.0). Forty-seven (17.5%) patients developed sepsis and 7 (2.6%) died of infection. Maternal illiteracy was associated with longer time from fever to decision to seek care (P = 0.029) and sepsis (odds ratio [OR] 3.06, 95% confidence interval [CI] 1.09-8.63; P = 0.034). More infectious deaths occurred in those with longer travel time to hospital (OR 1.36, 95% CI 1.03-1.81; P = 0.031) and in families with an annual household income <US$2,000 (OR 13.90, 95% CI 1.62-119.10; P = 0.016).
interpretationIlliteracy, poverty, and longer travel times are associated with delays in assessment and treatment of fever and with sepsis and infectious mortality in pediatric leukemia. Providing additional education to high-risk families and staying at a nearby guest house during periods of neutropenia may decrease sepsis and infectious mortality.
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