Predicting the risk of severe bacterial infection in children with chemotherapy-induced febrile neutropenia.
BACKGROUND
The prognosis of febrile neutropenia (FN) in childhood cancer has been considerably improved by the intensification of treatment, including systematic hospitalization and broad-spectrum antibiotics. As only few children present with a severe bacterial infection (SBI), clinical decision rules have been developed to distinguish those at risk for SBI. The aim of this study was to evaluate the reproducibility of six clinical decision rules proposed in the literature and to compare their performance.


METHODS
This retrospective two-center cohort study included all episodes of chemotherapy-induced FN in children admitted between January 2005 and December 2006. Each rule was applied to our patients. Their sensitivity (Se) and specificity (Sp) were calculated and compared with the authors' results, to assess reproducibility. The most predictive rule was defined in advance as that yielding 100% Se, the highest Sp, and the greatest simplicity for bedside application.


RESULTS
Three hundred seventy-seven episodes of FN in 167 patients were collected; 64 episodes were associated with SBI, including 36 with bacteremia. Four of the six rules were reproducible, but none were able to be validated. The most predictive rule for bacteremia had 96% Se (95% confidence interval (CI): 79-99%) and 25% Sp (95% CI: 19-33%), and the most predictive rule for SBI had 95% Se (95% CI: 87-98%), but no power of discrimination (Sp = 5%, 95% CI: 3-8%).


CONCLUSIONS
This study emphasizes the difficulty in identifying standardized decision rules in the management of a condition with numerous clinical variables like FN.
Macher
Emilie
E
Pediatric Hematology Unit, Lille-Nord de France University Hospital, Lille, France.
Dubos
François
F
Garnier
Nathalie
N
Delebarre
Mathilde
M
De Berranger
Eva
E
Thebaud
Estelle
E
Mazingue
Françoise
F
Leblond
Pierre
P
Martinot
Alain
A
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001424:Bacterial Infections / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D009503:Neutropenia / Q000150:complications*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors
D000970:Antineoplastic Agents