title: Development and validation of a prediction model for diagnosing blood stream infections in febrile, non-neutropenic children with cancer.
abstract: Pediatric oncology patients are at increased risk for blood stream infections (BSI). Risk in the absence of severe neutropenia (absolute neutrophil count [ANC] ≥500/µl) is not well defined.
  
  
  
  In a retrospective cohort of febrile (temperature ≥38.0° for >1 hr or ≥38.3°) pediatric oncology patients with ANC ≥500/µl, a diagnostic prediction model for BSI was constructed using logistic regression modeling and the following candidate predictors: age, ANC, absolute monocyte count, body temperature, inpatient/outpatient presentation, sex, central venous catheter type, hypotension, chills, cancer diagnosis, stem cell transplant, upper respiratory symptoms, and exposure to cytarabine, anti-thymocyte globulin, or anti-GD2 antibody. The model was internally validated with bootstrapping methods.
  
  
  
  Among 932 febrile episodes in 463 patients, we identified 91 cases of BSI. Independently significant predictors for BSI were higher body temperature (Odds ratio [OR] 2.36 P < 0.001), tunneled external catheter (OR 13.79 P < 0.001), peripherally inserted central catheter (OR 3.95 P = 0.005), elevated ANC (OR 1.19 P = 0.024), chills (OR 2.09 P = 0.031), and hypotension (OR 3.08 P = 0.004). Acute lymphoblastic leukemia diagnosis (OR 0.34 P = 0.026), increased age (OR 0.70 P = 0.049), and drug exposure (OR 0.08 P < 0.001) were associated with decreased risk for BSI. The risk prediction model had a C-index of 0.898; after bootstrapping adjustment for optimism, corrected C-index 0.885.
  
  
  
  We developed a diagnostic prediction model for BSI in febrile pediatric oncology patients without severe neutropenia. External validation is warranted before use in clinical practice. Pediatr Blood Cancer 2015;62:262-268. © 2014 Wiley Periodicals, Inc.
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.|Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Esbenshade
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors.forename: M Cecilia Di
authors.initials: MC
authors.lastname: Pentima
authors.affiliation: Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.|Vanderbilt Department of Biostatistics, Nashville, Tennessee.
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.|Vanderbilt Department of Biostatistics, Nashville, Tennessee.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Shintani
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Esbenshade
authors.affiliation: Vanderbilt School of Medicine, Nashville, Tennessee.
authors.forename: Monique E
authors.initials: ME
authors.lastname: Simpson
authors.affiliation: Vanderbilt School of Medicine, Nashville, Tennessee.
authors.forename: Kathleen C
authors.initials: KC
authors.lastname: Montgomery
authors.affiliation: Vanderbilt School of Medicine, Nashville, Tennessee.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Lindell
authors.affiliation: Vanderbilt School of Medicine, Nashville, Tennessee.
authors.forename: Haerin
authors.initials: H
authors.lastname: Lee
authors.affiliation: Vanderbilt School of Medicine, Nashville, Tennessee.
authors.forename: Ato
authors.initials: A
authors.lastname: Wallace
authors.affiliation: Vanderbilt School of Medicine, Nashville, Tennessee.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Garcia
authors.affiliation: Vanderbilt Department of Biostatistics, Nashville, Tennessee.|Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.
authors.forename: Karel G M
authors.initials: KG
authors.lastname: Moons
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.|Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Friedman
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D062905:Central Venous Catheters / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005334:Fever / Q000150:complications*; D006801:Humans; D008962:Models, Theoretical; D009369:Neoplasms / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: febrile neutropenia; infections in immunocompromised hosts; pediatric hematology/oncology; prediction modeling in cancer; support care