Evaluation of risk stratification strategies in pediatricpatients with febrile neutropenia

Abstract

Objective: To evaluate the performance of risk stratification protocols for febrile neutropeniaspecific to the pediatric population.Methods: Retrospective study of a cohort of pediatric patients undergoing cancer treatmentwith episodes of neutropenia due to chemotherapy and fever, treated at the emergencydepartment of a tertiary cancer hospital from January 2015 to June 2017. Patients who werebone marrow transplant recipients and patients with neutropenia due to causes other thanchemotherapy were excluded. Six protocols were applied to all patients: Rackoff, Alexander,Santolaya, Rondinelli, Ammann 2003, and Ammann 2010. The following outcomes were assessed:microbiological infection, death, ICU admission, and need for more than two antibiotics. Theperformance of each protocol was analyzed for sensitivity, specificity, positive predictive value(PPV), negative predictive value (NPV), and receiver operator characteristic (ROC) curve.Results: This study evaluated 199 episodes of febrile neutropenia in 118 patients. Microbiolog-ical infection was identified in 70 samples from 45 distinct episodes (22.6%), 30 patients usedmore than two antibiotics during treatment (15%), eight required ICU admission (4%), and onepatient died (0.8%). Three protocols achieved high sensitivity indices and NPV regarding theoutcomes of death and ICU admission: Alexander, Rackoff, and Ammann 2010; however, Rack-off showed higher sensitivity (0.82) and NPV (0.9) in relation to the microbiological infectionoutcome.Conclusion: The Rackoff risk rating showed the best performance in relation to microbiologicalinfection, death, and ICU admission, making it eligible for prospective evaluation