Predicting the risk of adverse events in children with febrile neutropenia: A validation of previously identified clinical decision rules

[摘要] ENGLISH SUMMARY: PurposeThe purpose of the study was to validate an existing clinical risk assessment tool (Ammann tool) to predict adverse events (AEs) in children with cancer and febrile neutropenia (FN).Patients and methodsPatients less than 16 years of age with confirmed malignancies receiving chemotherapy and who presented to the Tygerberg hospital paediatric oncology unit, with fever (axillary temperature > 38 C twice in 24 hours or > 38.5 C once) and neutropenia (neutrophil count < 500 cells/mm3) were enrolled. A risk prediction score1 was calculated for each patient according to the Ammann rule, and AEs were documented until antibiotics had been stopped and neutropenia resolved. The risk prediction score included haemoglobin > 9 g/dL, white cell count < 0.3 g/L, platelet count < 50 g/L and chemotherapy more intensive than acute lymphoblastic leukaemia maintenance therapy. AEs were defined as severe medical complications, microbiologically defined infection and radiologically confirmed pneumonia.ResultsThere were 100 FN episodes in 52 patients, of whom 54% had haematological malignancies, 44% solid tumours and 2% central nervous system tumours (relapsed malignancies 16%). The male:female ratio was 1.8:1 with a median age of 56 months (mean age of 71 months; range 8 to 175 months). AEs occurred in 18/57 (45%) patients with a low risk (score < 9) and 22/43 (55%) with a high risk (score ≥ 9), yieldinga sensitivity of 56.8%, specificity of 65%, positive predictive value of 50% and negative predictive value of 71%. Total WCC (p = < 0.01) and absolute monocyte count (p = 0.05) were significantly associated with an AE. Antibiotic-resistant microorganisms were found in 18% of microbiologically confirmed FN. There were marked differences in the patient cohorts between high-income countries versus a low- to middle-income country with a lower median age and more resistant organisms.ConclusionAlthough this study did not succeed in validating the risk assessment tool (Ammann tool), it demonstrated the important association between total WCC, absolute monocyte count and an AE during FN.

[发布机构] Stellenbosch University