title: Which decision rules meet methodological standards in children with febrile neutropenia? Results of a systematic review and analysis.
abstract: BACKGROUND
  Clinical decision rules (CDRs) have sought to identify the few children with chemotherapy-induced febrile neutropenia (FN) really at risk of severe infection to reduce the invasive procedures and costs for those at low risk. Several reports have shown that most rules do not perform well enough to be clinically useful. Our objective was to analyze the derivation methods and validation procedures of these CDRs.
  
  
  METHODS
  A systematic review using Medline, Ovid, Refdoc, and the Cochrane Library through December 2012 searched for all CDRs predicting the risk of severe infection and/or complications in children with chemotherapy-induced FN. Their methodological quality was analyzed by 17 criteria for deriving and validating a CDR identified in the literature. The criteria published by the Evidence Based Medicine Working Group were applied to the published validations of each CDR to assess their level of evidence.
  
  
  RESULTS
  The systematic research identified 612 articles and retained 12 that derived CDRs. Overall, the CDRs met a median of 65% of the methodological criteria. The criteria met least often were that the rule made clinical sense, or described the course of action, or that the variables and the CDR were reproducible. Only one CDR, developed in South America, met all methodological criteria and provided the highest level of evidence; unfortunately it was not reproducible in Europe.
  
  
  CONCLUSIONS
  Only one CDR developed for children with FN met all methodological standards and reached the highest level of evidence.
authors: Pediatric Emergency Unit and Infectious Diseases, UDSL, Lille University Hospital, Lille, France; EA2694, UDSL, Lille University Hospital, Lille, France; Pediatric Hematology Unit, UDSL, Lille University Hospital, Lille, France.
authors: Mathilde
authors: M
authors: Delebarre
authors: Emilie
authors: E
authors: Macher
authors: Françoise
authors: F
authors: Mazingue
authors: Alain
authors: A
authors: Martinot
authors: François
authors: F
authors: Dubos
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D002648:Child; D003661:Decision Support Techniques; D064147:Febrile Neutropenia / Q000139:chemically induced / Q000628:therapy*; D006801:Humans; D008495:Medical Oncology / Q000592:standards*; D010372:Pediatrics / Q000592:standards*
chemical_list: D000970:Antineoplastic Agents
keywords: children; decision rules; fever; methodology; neutropenia; review