title: Validation of risk stratification for children with febrile neutropenia in a pediatric oncology unit in India.
abstract: The study aims to validate a score predicting risk of complications in pediatric patients with chemotherapy-related febrile neutropenia (FN) and evaluate the performance of previously published models for risk stratification.
  
  
  
  Children diagnosed with cancer and presenting with FN were evaluated in a prospective single-center study. A score predicting the risk of complications, previously derived in the unit, was validated on a prospective cohort. Performance of six predictive models published from geographically distinct settings was assessed on the same cohort.
  
  
  
  Complications were observed in 109 (26.3%) of 414 episodes of FN over 15 months. A risk score based on undernutrition (two points), time from last chemotherapy (<7 days = two points), presence of a nonupper respiratory focus of infection (two points), C-reactive protein (>60 mg/l = five points), and absolute neutrophil count (<100 per μl = two points) was used to stratify patients into "low risk" (score <7, n = 208) and assessed using the following parameters: overall performance (Nagelkerke R2= 34.4%), calibration (calibration slope = 0.39; P = 0.25 in Hosmer-Lemeshow test), discrimination (c-statistic = 0.81), overall sensitivity (86%), negative predictive value (93%), and clinical net benefit (0.43). Six previously published rules demonstrated inferior performance in this cohort.
  
  
  
  An indigenous decision rule using five simple predefined variables was successful in identifying children at risk for complications. Prediction models derived in developed nations may not be appropriate for low-middle-income settings and need to be validated before use.
authors.affiliation: Pediatric Hematology-Oncology Unit, Tata Medical Center, Kolkata, West Bengal, India.
authors.forename: Anirban
authors.initials: A
authors.lastname: Das
authors.affiliation: Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India.
authors.forename: Amita
authors.initials: A
authors.lastname: Trehan
authors.affiliation: Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India.
authors.forename: Sapna
authors.initials: S
authors.lastname: Oberoi
authors.affiliation: Pediatric Hematology-Oncology Unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Bansal
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000097:blood / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008954:Models, Biological; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology*; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors
chemical_list: D002097:C-Reactive Protein
keywords: clinical decision rule; complications; infections; low risk; undernutrition