Guidelines for diagnosing and treating pulmonary infiltrates in children with acute leukaemia: impact of timely decisions

Aim: Children with leukaemia are at increased risk of pulmonary complications, often with unspecific clinical data, delayed diagnosis and a high mortality rate. We evaluated the usefulness of diagnostic–therapeutic guidelines (DTG) in which specific times for decision making were incorporated. Methods: Clinical charts of children with acute leukaemia and suspicion of pulmonary involvement were reviewed. Patients were allocated to group I if their diagnostic and therapeutic decisions were in accordance with the DTG, and to group II if not. Results: Children from group I (n = 32) and group II (n = 28) did not differ with respect to age (9.3 ± 0.5 years old, mean ± SEM), gender, type, risk and stage of leukaemia, anaemia and neutropenia. Total length of hospital stay and hospitalization due to the pulmonary disease were shorter in group I than in group II (14.8 ± 2.1 vs. 28.5 ± 3.7 days, p = 0.0016; and 10.8 ± 1.0 vs. 18.4±1.8 days, p = 0.0003, respectively). Two patients (6.3%) died due to the pulmonary pathology in group I, and nine (32.1%, p = 0.016) in group II. Conclusions: Diagnostic–therapeutic guidelines that incorporate timely decisions constitute a useful algorithm to reduce the length of hospital stay and mortality in children with acute leukaemia and pulmonary infiltrates. A prospective study is needed to validate these results.