External Validation of Six Pediatric Fever and Neutropenia Clinical Decision Rules

Haeusler, GM; Thursky, KA; Slavin, MA; Mechinaud, F; Babl, FE; Bryant, P; De Abreu Lourenco, R; Phillips, R

External Validation of Six Pediatric Fever and Neutropenia Clinical Decision Rules

Haeusler, GM Thursky, KA Slavin, MA Mechinaud, F Babl, FE Bryant, P De Abreu Lourenco, R

Phillips, R

Permalink

Publication Type:: Journal Article
Citation:: Pediatric Infectious Disease Journal, 2018, 37 (4), pp. 329 - 335
Issue Date:: 2018-04-01

Closed Access

	Filename	Description	Size
	rdal_ped_ifect_dis_j.pdf	Published Version	239.43 kB	Adobe PDF	View/Open

Copyright Clearance Process

Recently Added
In Progress
Closed Access

This item is closed access and not available.

Full metadata record

Field	Value	Language
dc.contributor.author	Haeusler, GM	en_US
dc.contributor.author	Thursky, KA	en_US
dc.contributor.author	Slavin, MA	en_US
dc.contributor.author	Mechinaud, F	en_US
dc.contributor.author	Babl, FE	en_US
dc.contributor.author	Bryant, P	en_US
dc.contributor.author	De Abreu Lourenco, R https://orcid.org/0000-0002-5978-8774	en_US
dc.contributor.author	Phillips, R	en_US
dc.date.issued	2018-04-01	en_US
dc.identifier.citation	Pediatric Infectious Disease Journal, 2018, 37 (4), pp. 329 - 335	en_US
dc.identifier.issn	0891-3668	en_US
dc.identifier.uri	http://hdl.handle.net/10453/130291
dc.description.abstract	Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. Background: Fever and neutropenia (FN) clinical decision rules (CDRs) are recommended to help distinguish children with cancer at high and low risk of severe infection. The aim of this study was to validate existing pediatric FN CDRs designed to stratify children with cancer at high or low risk of serious infection or medical complication. Methods: Pediatric CDRs suitable for validation were identified from a literature search. Relevant data were extracted from an existing data set of 650 retrospective FN episodes in children with cancer. The sensitivity and specificity of each of the CDR were compared with the derivation studies to assess reproducibility. Results: Six CDRs were identified for validation: 2 were designed to predict bacteremia and 4 to predict adverse events. Five CDRs exhibited reproducibility in our cohort. A rule predicting bacteremia had the highest sensitivity (100%; 95% confidence interval (CI): 93%-100%) although poor specificity (17%), with only 15% identified as low risk. For adverse events, the highest sensitivity achieved was 84% (95% CI: 75%-90%), with specificity of 29% and 27% identified as low risk. A rule intended for application after a 24-hour period of inpatient observation yielded a sensitivity of 80% (95% CI: 73-86) and specificity of 46%, with 44% identified as low risk. Conclusions: Five CDRs were reproducible, although not all can be recommended for implementation because of either inadequate sensitivity or failure to identify a clinically meaningful number of low-risk patients. The 24-hour rule arguably exhibits the best balance between sensitivity and specificity in our population.	en_US
dc.relation.ispartof	Pediatric Infectious Disease Journal	en_US
dc.relation.isbasedon	10.1097/INF.0000000000001777	en_US
dc.subject.classification	Pediatrics	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Bacteremia	en_US
dc.subject.mesh	Neoplasms	en_US
dc.subject.mesh	Neutropenia	en_US
dc.subject.mesh	Fever of Unknown Origin	en_US
dc.subject.mesh	Sensitivity and Specificity	en_US
dc.subject.mesh	Reproducibility of Results	en_US
dc.subject.mesh	Decision Support Techniques	en_US
dc.subject.mesh	Adolescent	en_US
dc.subject.mesh	Child	en_US
dc.subject.mesh	Child, Preschool	en_US
dc.subject.mesh	Infant	en_US
dc.subject.mesh	Infant, Newborn	en_US
dc.subject.mesh	Drug-Related Side Effects and Adverse Reactions	en_US
dc.title	External Validation of Six Pediatric Fever and Neutropenia Clinical Decision Rules	en_US
dc.type	Journal Article
utslib.citation.volume	4	en_US
utslib.citation.volume	37	en_US
utslib.for	1114 Paediatrics and Reproductive Medicine	en_US
utslib.for	1117 Public Health and Health Services	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Business
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
utslib.copyright.status	closed_access
pubs.issue	4	en_US
pubs.publication-status	Published	en_US
pubs.volume	37	en_US

Abstract:

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. Background: Fever and neutropenia (FN) clinical decision rules (CDRs) are recommended to help distinguish children with cancer at high and low risk of severe infection. The aim of this study was to validate existing pediatric FN CDRs designed to stratify children with cancer at high or low risk of serious infection or medical complication. Methods: Pediatric CDRs suitable for validation were identified from a literature search. Relevant data were extracted from an existing data set of 650 retrospective FN episodes in children with cancer. The sensitivity and specificity of each of the CDR were compared with the derivation studies to assess reproducibility. Results: Six CDRs were identified for validation: 2 were designed to predict bacteremia and 4 to predict adverse events. Five CDRs exhibited reproducibility in our cohort. A rule predicting bacteremia had the highest sensitivity (100%; 95% confidence interval (CI): 93%-100%) although poor specificity (17%), with only 15% identified as low risk. For adverse events, the highest sensitivity achieved was 84% (95% CI: 75%-90%), with specificity of 29% and 27% identified as low risk. A rule intended for application after a 24-hour period of inpatient observation yielded a sensitivity of 80% (95% CI: 73-86) and specificity of 46%, with 44% identified as low risk. Conclusions: Five CDRs were reproducible, although not all can be recommended for implementation because of either inadequate sensitivity or failure to identify a clinically meaningful number of low-risk patients. The 24-hour rule arguably exhibits the best balance between sensitivity and specificity in our population.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/130291