4.7 When to consult the Tertiary Centre

It is anticipated that some pediatric oncology patients under care in satellite centers will experience treatment complications and/or deterioration in health status which will be an indication to transfer to the appropriate tertiary centre.  The list below is an attempt highlight conditions which, when present or suspected, should prompt consultation with and possible transfer to the patient’s tertiary centre.

1. Fever and Neutropenia
   • Patients presenting with sepsis syndrome
   • Patients with persistent fever beyond 5 days
   • Patients with presumed surgical focus (including conditions such as appendicitis and typhlitis)
2. Interstitial pneumonitis/ pneumocystis pneumonia
3. Pleural effusion
4. Pericardial effusion
5. Intracranial bleed
6. New or worsening mediastinal mass
7. Spinal cord compression
8. Seizures or unexplained or new neurological symptoms
9. Suspected or confirmed increased intracranial pressure
10. Superior vena cava syndrome
11. Bowel obstruction
12. Uncontrolled bleeding (blood product administration should not be delayed while arranging transfer)
13. Concern of relapse, or regrowth of tumour

Note: Bone marrow aspirates, tumour biopsies, and diagnostics such as bronchoscopy are not to be performed in the satellite centre as the procedure will be repeated in the tertiary centre.

Updated by Dr. Paul Gibson, Children’s Hospital, London Health Sciences Centre, 2015