Pediatric Hematology Unit, Lille-Nord de France University Hospital, Lille, France.
Pediatr Blood Cancer. 2010 Oct;55(4):662-7. doi: 10.1002/pbc.22586.
The prognosis of febrile neutropenia (FN) in childhood cancer has been considerably improved by the intensification of treatment, including systematic hospitalization and broad-spectrum antibiotics. As only few children present with a severe bacterial infection (SBI), clinical decision rules have been developed to distinguish those at risk for SBI. The aim of this study was to evaluate the reproducibility of six clinical decision rules proposed in the literature and to compare their performance.
This retrospective two-center cohort study included all episodes of chemotherapy-induced FN in children admitted between January 2005 and December 2006. Each rule was applied to our patients. Their sensitivity (Se) and specificity (Sp) were calculated and compared with the authors' results, to assess reproducibility. The most predictive rule was defined in advance as that yielding 100% Se, the highest Sp, and the greatest simplicity for bedside application.
Three hundred seventy-seven episodes of FN in 167 patients were collected; 64 episodes were associated with SBI, including 36 with bacteremia. Four of the six rules were reproducible, but none were able to be validated. The most predictive rule for bacteremia had 96% Se (95% confidence interval (CI): 79-99%) and 25% Sp (95% CI: 19-33%), and the most predictive rule for SBI had 95% Se (95% CI: 87-98%), but no power of discrimination (Sp = 5%, 95% CI: 3-8%).
This study emphasizes the difficulty in identifying standardized decision rules in the management of a condition with numerous clinical variables like FN.
通过强化治疗，包括系统住院治疗和广谱抗生素，儿童癌症并发发热性中性粒细胞减少症（FN）的预后已得到显著改善。由于只有少数儿童存在严重细菌感染（SBI），因此已开发出临床决策规则来区分那些存在 SBI 风险的患者。本研究旨在评估文献中提出的六种临床决策规则的重现性，并比较它们的性能。
这是一项回顾性的双中心队列研究，纳入了 2005 年 1 月至 2006 年 12 月期间因化疗引起 FN 而住院的所有儿童患者。将每个规则应用于我们的患者。计算其敏感性（Se）和特异性（Sp），并与作者的结果进行比较，以评估重现性。预先定义最具预测性的规则为产生 100%Se、最高 Sp 和最易于床边应用的规则。
共收集了 167 名患者 377 例 FN 发作，其中 64 例与 SBI 相关，包括 36 例菌血症。六种规则中有四种是可重现的，但均无法验证。对菌血症最具预测性的规则具有 96%的 Se（95%置信区间[CI]：79-99%）和 25%的 Sp（95% CI：19-33%），对 SBI 最具预测性的规则具有 95%的 Se（95% CI：87-98%），但没有鉴别力（Sp = 5%，95% CI：3-8%）。
本研究强调了在 FN 等具有众多临床变量的情况下，识别标准化决策规则的困难。
