Risk stratification in children with cancer and febrile neutropenia: A national, prospective, multicentre validation of nine clinical decision rules

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

Risk stratification in children with cancer and febrile neutropenia: A national, prospective, multicentre validation of nine clinical decision rules

Haeusler, GM Thursky, KA Slavin, MA Babl, FE De Abreu Lourenco, R

Allaway, Z Mechinaud, F Phillips, R

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Publication Type:: Journal Article
Citation:: EClinicalMedicine, 2020, 18
Issue Date:: 2020-01-01

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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	Babl, FE	en_US
dc.contributor.author	De Abreu Lourenco, R https://orcid.org/0000-0002-5978-8774	en_US
dc.contributor.author	Allaway, Z	en_US
dc.contributor.author	Mechinaud, F	en_US
dc.contributor.author	Phillips, R	en_US
dc.date.available	2019-11-18	en_US
dc.date.issued	2020-01-01	en_US
dc.identifier.citation	EClinicalMedicine, 2020, 18	en_US
dc.identifier.uri	http://hdl.handle.net/10453/137726
dc.description.abstract	© 2019 Background: Reduced intensity treatment of low-risk febrile neutropenia (FN) in children with cancer is safe and improves quality of life. Identifying children with low-risk FN using a validated risk stratification strategy is recommended. This study prospectively validated nine FN clinical decision rules (CDRs) designed to predict infection or adverse outcome. Methods: Data were collected on consecutive FN episodes in this multicentre, prospective validation study. The reproducibility and discriminatory ability of each CDR in the validation cohort was compared to the derivation dataset and details of missed outcomes were reported. Findings: There were 858 FN episodes in 462 patients from eight hospitals included. Bacteraemia occurred in 111 (12·9%) and a non-bacteraemia microbiological documented infection in 185 (21·6%). Eight CDRs exhibited reproducibility and sensitivity ranged from 64% to 96%. Rules that had >85% sensitivity in predicting outcomes classified few patients (<20%) as low risk. For three CDRs predicting a composite outcome of any bacterial or viral infection, the sensitivity and discriminatory ability improved for prediction of bacterial infection alone. Across all CDRs designed to be implemented at FN presentation, the sensitivity improved at day 2 assessment. Interpretation: While reproducibility was observed in eight out of the nine CDRs, no rule perfectly differentiated between children with FN at high or low risk of infection. This is in keeping with other validation studies and highlights the need for additional safeguards against missed infections or adverse outcomes before implementation can be considered.	en_US
dc.relation	http://purl.org/au-research/grants/nhmrc/APP 1104527
dc.relation	http://purl.org/au-research/grants/nhmrc/1104527
dc.relation.ispartof	EClinicalMedicine	en_US
dc.relation.isbasedon	10.1016/j.eclinm.2019.11.013	en_US
dc.title	Risk stratification in children with cancer and febrile neutropenia: A national, prospective, multicentre validation of nine clinical decision rules	en_US
dc.type	Journal Article
utslib.citation.volume	18	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	open_access
pubs.publication-status	Published	en_US
pubs.volume	18	en_US

Abstract:

© 2019 Background: Reduced intensity treatment of low-risk febrile neutropenia (FN) in children with cancer is safe and improves quality of life. Identifying children with low-risk FN using a validated risk stratification strategy is recommended. This study prospectively validated nine FN clinical decision rules (CDRs) designed to predict infection or adverse outcome. Methods: Data were collected on consecutive FN episodes in this multicentre, prospective validation study. The reproducibility and discriminatory ability of each CDR in the validation cohort was compared to the derivation dataset and details of missed outcomes were reported. Findings: There were 858 FN episodes in 462 patients from eight hospitals included. Bacteraemia occurred in 111 (12·9%) and a non-bacteraemia microbiological documented infection in 185 (21·6%). Eight CDRs exhibited reproducibility and sensitivity ranged from 64% to 96%. Rules that had >85% sensitivity in predicting outcomes classified few patients (<20%) as low risk. For three CDRs predicting a composite outcome of any bacterial or viral infection, the sensitivity and discriminatory ability improved for prediction of bacterial infection alone. Across all CDRs designed to be implemented at FN presentation, the sensitivity improved at day 2 assessment. Interpretation: While reproducibility was observed in eight out of the nine CDRs, no rule perfectly differentiated between children with FN at high or low risk of infection. This is in keeping with other validation studies and highlights the need for additional safeguards against missed infections or adverse outcomes before implementation can be considered.

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http://hdl.handle.net/10453/137726