title: Systematic review and meta-analysis of the discriminatory performance of risk prediction rules in febrile neutropaenic episodes in children and young people.
abstract: BACKGROUND
  Febrile neutropaenia is a frequently occurring and occasionally life-threatening complication of treatment for childhood cancer, yet many children are aggressively over-treated. We aimed to undertake a systematic review and meta-analysis to summarise evidence on the discriminatory ability and predictive accuracy of clinical decision rules (CDR) of risk stratification in febrile neutropaenic episodes.
  
  
  METHODS
  The review was conducted in accordance with Centre for Reviews and Dissemination methods, using random effects models to undertake meta-analysis. It was registered with the HTA Registry of systematic reviews, CRD32009100453.
  
  
  RESULTS
  We found 20 studies describing 16 different CDR assessed in 8388 episodes of FNP. No study compared different approaches and only one CDR had been subject to testing across multiple datasets. This review cannot conclude that any system is more effective or reliable than any other.
  
  
  CONCLUSIONS
  To maximise the value of the information already collected by these and other cohorts of children with febrile neutropaenia, an individual-patient-data (IPD) meta-analysis is required to develop and test new and existing CDR to improve stratification and optimise therapy.
authors.affiliation: Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK. rp532@york.ac.uk
authors.forename: Bob
authors.initials: B
authors.lastname: Phillips
authors.forename: Ros
authors.initials: R
authors.lastname: Wade
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Stewart
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Sutton
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D005334:Fever / Q000209:etiology*; D006801:Humans; D007223:Infant; D009503:Neutropenia / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D055815:Young Adult