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Researchers Study Pediatric FN Episodes to Predict Risk of Complications, Validate Clinical Decision Rules

Jaime Rosenberg
Seeking to generate data for the development and validation of clinical decision rules in pediatric febrile neutropenia (FN), researchers used 2 decades of data on FN episodes in pediatric patients.
About half of pediatric patients—those under age 17—develop at least 1 episode of febrile neutropenia (FN), but bacterial infection is identified in just a minority of patients, suggesting overtreatment as the main cause of FN in these patients.

With a wide range of negative impacts stemming from overtreatment, including increased costs, bacterial resistance, risk of nosocomial infections, and reduced quality of life, clinical decision rules (CDRs) have been developed and widely applied to predict the risk of complications in adult patients. While CDRs are also recommended in pediatric oncology, they are rarely used in practice.

Seeking to generate data for the development and validation of CDRs in pediatric FN, researchers used 2 decades of data, from 1993 to 2012, and identified 703 FN episodes in 291 patients being treated with chemotherapy. The median number of episodes of FN was 2 and the maximum was 9. The researchers observed bacteremia in 148 (21%) and severe bacterial infection in 357 (51%) of episodes.

According to the researchers, the distribution of gender and age at diagnosis did not change significantly over the 2 decades. “Routine management for patients with FN included emergency hospitalization and empirical broad-spectrum intravenous antimicrobial therapy, usually once daily ceftriaxone plus amikacin,” they noted.

They collected long-term data on 29 predefined characteristics in pediatric patients at diagnosis of FN that are hypothesized to be associated with bacteremia and severe bacterial infection. The characteristics included 6 patient- and cancer-related characteristics, including sex, age, and type of cancer. Eight characteristics related to patient history, such as time period of FN diagnosis and intensity of chemotherapy, and 8 clinical examination characteristics, such as highest recorded temperature and clinical signs of bacterial infections, were also collected.

Lastly, 7 laboratory characteristics, including hemoglobin and leukocyte count, were collected.

Assessing the 703 episodes, the researchers noted 28 outcomes, 8 of which described the treatment of neutropenia. Six outcomes described microbiologically defined infections like bacteremia and 4 described clinically defined infections, such as pneumonia. To facilitate analysis, the researchers defined 4 additional clinical composite outcomes, including a serious medical complication and intensive care unit treatment.

Six discharge-related outcomes, including discharge with versus without antibiotics and absolute leukocyte, neutrophil, monocyte, and phagocyte counts, were also defined.

“These data can mainly be used to study [FN] characteristics over time and between centers; to study the association of [FN] characteristics with outcomes over time and between centers; to derive corresponding CDRs for risk-adapted treatment of [FN] in pediatric patients; and to externally validate CDRs derived from other datasets,” explained to the researchers.

Based on the analysis, a single data record containing information on characteristics and outcomes of the episodes has been created.

Reference:

Zermatten M, Koenig C, Allmen A, Agyeman P, Ammann R. Episodes of fever in neutropenia in pediatric patients with cancer in Bern, Switzerland, 1993-2012 [published online January 15, 2019]. Sci Data. doi: 10.1038/sdata.2018.304.

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