| Predicting the risk of severe bacterial infection in children with chemotherapy-induced febrile neutropenia. | |
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MedLine Citation:
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PMID: 20806364 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The prognosis of febrile neutropenia (FN) in childhood cancer has been considerably improved by the intensification of treatment, including systematic hospitalization and broad-spectrum antibiotics. As only few children present with a severe bacterial infection (SBI), clinical decision rules have been developed to distinguish those at risk for SBI. The aim of this study was to evaluate the reproducibility of six clinical decision rules proposed in the literature and to compare their performance. METHODS: This retrospective two-center cohort study included all episodes of chemotherapy-induced FN in children admitted between January 2005 and December 2006. Each rule was applied to our patients. Their sensitivity (Se) and specificity (Sp) were calculated and compared with the authors' results, to assess reproducibility. The most predictive rule was defined in advance as that yielding 100% Se, the highest Sp, and the greatest simplicity for bedside application. RESULTS: Three hundred seventy-seven episodes of FN in 167 patients were collected; 64 episodes were associated with SBI, including 36 with bacteremia. Four of the six rules were reproducible, but none were able to be validated. The most predictive rule for bacteremia had 96% Se (95% confidence interval (CI): 79-99%) and 25% Sp (95% CI: 19-33%), and the most predictive rule for SBI had 95% Se (95% CI: 87-98%), but no power of discrimination (Sp = 5%, 95% CI: 3-8%). CONCLUSION: This study emphasizes the difficulty in identifying standardized decision rules in the management of a condition with numerous clinical variables like FN. |
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Authors:
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Emilie Macher; François Dubos; Nathalie Garnier; Mathilde Delebarre; Eva De Berranger; Estelle Thebaud; Françoise Mazingue; Pierre Leblond; Alain Martinot |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Pediatric blood & cancer Volume: 55 ISSN: 1545-5017 ISO Abbreviation: Pediatr Blood Cancer Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-08-31 Completed Date: 2010-09-27 Revised Date: 2011-05-27 |
Medline Journal Info:
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Nlm Unique ID: 101186624 Medline TA: Pediatr Blood Cancer Country: United States |
Other Details:
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Languages: eng Pagination: 662-7 Citation Subset: IM |
Copyright Information:
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Copyright 2010 Wiley-Liss, Inc. |
Affiliation:
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Pediatric Hematology Unit, Lille-Nord de France University Hospital, Lille, France. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Antineoplastic Agents / adverse effects* Bacterial Infections / etiology* Child Child, Preschool Cohort Studies Female Fever / complications* Humans Infant Male Neutropenia / complications* Reproducibility of Results Retrospective Studies Risk Factors |
| Chemical | |
Reg. No./Substance:
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0/Antineoplastic Agents |
| Comments/Corrections | |
Comment In:
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Pediatr Blood Cancer. 2011 Jul 1;56(7):1152; author reply 1153
[PMID:
21319283
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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