BACKGROUND: To identify predictors for 2 risk measures-"proven invasive bacterial infection or culture-negative sepsis (IBD)" and "clinical complications (CC)"-in pediatric cancer patients with fever and neutropenia (FN). METHODS: Records of 390 patients with FN hospitalized over 2 years were reviewed. For the 332 who met inclusion criteria, one FN episode was randomly selected. Independent predictors at presentation were analyzed using multiple regression models. Optimal cut-off risk prediction scores were determined. These models were validated by bootstrap analysis. RESULTS: Patients' median age was 6.0 years; 66% had an underlying diagnosis of leukemia. Independent predictors of IBD (n = 56) were absolute neutrophil count <100, temperature at presentation > or =39.0 degrees C, "sick" clinical appearance, and underlying diagnosis of acute myeloid leukemia. A total weighted score <24 reliably identified patients at low risk for IBD. Independent predictors of CC (n = 47) were relapse of malignancy, non-white race, "sick" clinical appearance, and underlying diagnosis of acute myeloid leukemia. A total weighted score <19 predicted patients at low risk for CC. Of those misclassified as low risk, 11 of 12 with IBD and 3 of 9 with CC had the outcome within 24 hours of presentation. Of the remaining patients classified as low-risk for IBD and CC, 99.5% and 97.1%, respectively, remained outcome-free after 24 hours of observation. CONCLUSIONS: This study identifies predictors of infection/complications in pediatric patients with FN, establishes clinical cut-off scores and highlights the importance of the initial clinical impression and 24 hours of observation. These prediction models warrant prospective validation.
BACKGROUND: To identify predictors for 2 risk measures-"proven invasive bacterial infection or culture-negative sepsis (IBD)" and "clinical complications (CC)"-in pediatric cancerpatients with fever and neutropenia (FN). METHODS: Records of 390 patients with FN hospitalized over 2 years were reviewed. For the 332 who met inclusion criteria, one FN episode was randomly selected. Independent predictors at presentation were analyzed using multiple regression models. Optimal cut-off risk prediction scores were determined. These models were validated by bootstrap analysis. RESULTS:Patients' median age was 6.0 years; 66% had an underlying diagnosis of leukemia. Independent predictors of IBD (n = 56) were absolute neutrophil count <100, temperature at presentation > or =39.0 degrees C, "sick" clinical appearance, and underlying diagnosis of acute myeloid leukemia. A total weighted score <24 reliably identified patients at low risk for IBD. Independent predictors of CC (n = 47) were relapse of malignancy, non-white race, "sick" clinical appearance, and underlying diagnosis of acute myeloid leukemia. A total weighted score <19 predicted patients at low risk for CC. Of those misclassified as low risk, 11 of 12 with IBD and 3 of 9 with CC had the outcome within 24 hours of presentation. Of the remaining patients classified as low-risk for IBD and CC, 99.5% and 97.1%, respectively, remained outcome-free after 24 hours of observation. CONCLUSIONS: This study identifies predictors of infection/complications in pediatric patients with FN, establishes clinical cut-off scores and highlights the importance of the initial clinical impression and 24 hours of observation. These prediction models warrant prospective validation.
Authors: Adam J Esbenshade; M Cecilia Di Pentima; Zhiguo Zhao; Ayumi Shintani; Jennifer C Esbenshade; Monique E Simpson; Kathleen C Montgomery; Robert B Lindell; Haerin Lee; Ato Wallace; Kelly L Garcia; Karel G M Moons; Debra L Friedman Journal: Pediatr Blood Cancer Date: 2014-10-18 Impact factor: 3.167
Authors: Fabian J S van der Velden; Gabriella de Vries; Alexander Martin; Emma Lim; Ulrich von Both; Laura Kolberg; Enitan D Carrol; Aakash Khanijau; Jethro A Herberg; Tisham De; Rachel Galassini; Taco W Kuijpers; Federico Martinón-Torres; Irene Rivero-Calle; Clementien L Vermont; Nienke N Hagedoorn; Marko Pokorn; Andrew J Pollard; Luregn J Schlapbach; Maria Tsolia; Irini Elefhteriou; Shunmay Yeung; Dace Zavadska; Colin Fink; Marie Voice; Werner Zenz; Benno Kohlmaier; Philipp K A Agyeman; Effua Usuf; Fatou Secka; Ronald de Groot; Michael Levin; Michiel van der Flier; Marieke Emonts Journal: Eur J Pediatr Date: 2022-10-15 Impact factor: 3.860