Abstract

Risk stratification of pediatric febrile neutropenia (FN) is an established concept, yet clinical risk tools misclassify nearly 5% of clinical standard-risk episodes with severe outcomes. The internal evaluation of a clinical risk tool before implementation has not been well-described. In this noninterventional cohort study, we evaluated a study decision rules (SDR) tool; a clinical risk tool with serial procalcitonin. The study standard-risk (SSR) group met clinical standard-risk criteria with two serial procalcitonin <0.4 ng/mL. The study high-risk (SHR) group met clinical high-risk criteria or clinical standard-risk with a procalcitonin ≥0.4 ng/mL. Descriptive and bivariate statistics compared the groups and outcomes. Clinical criteria alone identified 39.1% (238/608) standard-risk episodes; 5.9% (14/238) had severe events. Prospectively using the SDR, the SHR group encompassed 76.6% (92/120) of episodes; severe events occurred in 20% (3/15) of standard-risk episodes included due to elevated procalcitonin ≥0.4 ng/mL. The SHR group had more blood stream infections [21.7% (20/92) vs. 0% (0/28); P = 0.007] and intensive care admissions [13% (12/92) vs. 3.6% (1/28); P = 0.158]. In conclusion, the SDR with serial procalcitonin aided in identifying severe events in clinical standard-risk episodes, but analysis was limited. Institutions may consider similar internal evaluation methodology before FN episode risk stratification.

摘要

小儿发热性中性粒细胞减少症 (FN) 的风险分层是一个既定概念，但临床风险工具将近 5% 的具有严重后果的临床标准风险事件错误分类。临床风险工具在实施前的内部评估尚未得到很好的描述。在这项非干预性队列研究中，我们评估了研究决策规则 (SDR) 工具；具有系列降钙素原的临床风险工具。研究标准风险 (SSR) 组符合临床标准风险标准，其中两个系列降钙素原 <0.4 ng/mL。研究高风险 (SHR) 组符合降钙素原≥0.4 ng/mL 的临床高风险标准或临床标准风险。描述性和双变量统计比较了组和结果。仅临床标准就确定了 39.1% (238/608) 标准风险事件；5.9% (14/238) 有严重事件。前瞻性地使用 SDR，SHR 组包含 76.6% (92/120) 的发作；由于降钙素原升高≥0.4 ng/mL，严重事件发生在 20% (3/15) 的标准风险事件中。SHR 组有更多的血流感染 [21.7% (20/92) 对 0% (0/28)；P  = 0.007] 和重症监护入院率 [13% (12/92) 对 3.6% (1/28)；P  = 0.158]。总之，连续降钙素原的 SDR 有助于识别临床标准风险事件中的严重事件，但分析有限。在 FN 事件风险分层之前，机构可能会考虑类似的内部评估方法。