title: Risk prediction in pediatric cancer patients with fever and neutropenia.
abstract: BACKGROUND
  To identify predictors for 2 risk measures-"proven invasive bacterial infection or culture-negative sepsis (IBD)" and "clinical complications (CC)"-in pediatric cancer patients with fever and neutropenia (FN).
  
  
  METHODS
  Records of 390 patients with FN hospitalized over 2 years were reviewed. For the 332 who met inclusion criteria, one FN episode was randomly selected. Independent predictors at presentation were analyzed using multiple regression models. Optimal cut-off risk prediction scores were determined. These models were validated by bootstrap analysis.
  
  
  RESULTS
  Patients' median age was 6.0 years; 66% had an underlying diagnosis of leukemia. Independent predictors of IBD (n = 56) were absolute neutrophil count <100, temperature at presentation > or =39.0 degrees C, "sick" clinical appearance, and underlying diagnosis of acute myeloid leukemia. A total weighted score <24 reliably identified patients at low risk for IBD. Independent predictors of CC (n = 47) were relapse of malignancy, non-white race, "sick" clinical appearance, and underlying diagnosis of acute myeloid leukemia. A total weighted score <19 predicted patients at low risk for CC. Of those misclassified as low risk, 11 of 12 with IBD and 3 of 9 with CC had the outcome within 24 hours of presentation. Of the remaining patients classified as low-risk for IBD and CC, 99.5% and 97.1%, respectively, remained outcome-free after 24 hours of observation.
  
  
  CONCLUSIONS
  This study identifies predictors of infection/complications in pediatric patients with FN, establishes clinical cut-off scores and highlights the importance of the initial clinical impression and 24 hours of observation. These prediction models warrant prospective validation.
authors.affiliation: Department of Infectious Diseases, Mail Stop 600, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA. Hana.Hakim@stjude.org
authors.forename: Hana
authors.initials: H
authors.lastname: Hakim
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Flynn
authors.forename: Deo Kumar
authors.initials: DK
authors.lastname: Srivastava
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Knapp
authors.forename: Chenghong
authors.initials: C
authors.lastname: Li
authors.forename: James
authors.initials: J
authors.lastname: Okuma
authors.forename: Aditya H
authors.initials: AH
authors.lastname: Gaur
mesh_terms: D000293:Adolescent; D001424:Bacterial Infections / Q000175:diagnosis* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000209:etiology*; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis* / Q000473:pathology*