ArticleEClinicalMedicine2020
Re-evaluating and recalibrating predictors of bacterial infection in children with cancer and febrile neutropenia.
Article in EClinicalMedicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 41 citations in OpenAlex.
- Procalcitonin and Interleukin-10 May Assist in Early Prediction of Bacteraemia in Children With Cancer and Febrile Neutropenia.Frontiers in immunology · 2021Trial
- Bacterial bloodstream infections in pediatric oncology patients in a tertiary medical center: pathogen distribution, antimicrobial nonsusceptibility, and outcomes.European journal of pediatrics · 2026Article
- CD48 as a Novel Early Biomarker Complementing Procalcitonin and Lactate for Predicting Bacteremia in Pediatric Febrile Neutropenia: A Prospective Cohort Study.Mediterranean journal of hematology and infectious diseases · 2026Article
- Fever in Children with Cancer: Pathophysiological Insights Using Blood Transcriptomics.International journal of molecular sciences · 2025Article
- Clinical Decision Support to Reduce Hospital Length-of-Stay for Cancer Patients with Fever and Neutropenia.Applied clinical informatics · 2025Article
- Identification of factors predicting low-risk febrile neutropenia admissions in adults with acute myeloid leukemia.Blood advances · 2024Article
- Impact of time to antibiotics on clinical outcome in paediatric febrile neutropenia: a target trial emulation of 1685 episodes.The Lancet regional health. Western Pacific · 2024Article
- Economic implications of step-down outpatient management for fever and neutropenia episodes in pediatric cancer patients: a cost minimization analysis.BMC health services research · 2024Article
- Does Fever Response to Acetaminophen Predict Bloodstream Infections in Febrile Neutropenia?Cureus · 2023Article
- Can I go home now? The safety and efficacy of a new UK paediatric febrile neutropenia protocol for risk-stratified early discharge on oral antibiotics.Archives of disease in childhood · 2023Article
- Article
- Predictors of Septic Shock or Bacteremia in Children Experiencing Febrile Neutropenia Post-Chemotherapy.Journal of the Pediatric Infectious Diseases Society · 2022Article
- PAnTher Cub: procalcitonin-guided antibiotic therapy for febrile neutropenia in children and young people with cancer - a single-arm pilot study.BMJ paediatrics open · 2022Article
- Blood transcriptomics identifies immune signatures indicative of infectious complications in childhood cancer patients with febrile neutropenia.Clinical & translational immunology · 2022Article
- Survey of practices for the clinical management of febrile neutropenia in children in hematology-oncology units in Latin America.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2021Article
- SARS-CoV-2 in children with cancer or after haematopoietic stem cell transplant: An analysis of 131 patients.European journal of cancer (Oxford, England : 1990) · 2021Observational
- Managing low-risk febrile neutropenia in children in the time of COVID-19: What matters to parents and clinicians.Journal of paediatrics and child health · 2021Article
- Home-based care of low-risk febrile neutropenia in children-an implementation study in a tertiary paediatric hospital.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2021Article
- Optimising Antimicrobial Selection and Duration in the Treatment of Febrile Neutropenia in Children.Infection and drug resistance · 2021Review
Corrections and comments
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Authors and funding
8 authors at 5 institutions in 3 countries.
Funding
Abstract
backgroundNumerous paediatric febrile neutropenia (FN) clinical decision rules (CDRs) have been derived. Validation studies show reduced performance in external settings. We evaluated the association between variables common across published FN CDRs and bacterial infection and recalibrated existing CDRs using these data.
methodsProspective data from the Australian-PICNICC study which enrolled 858 FN episodes in children with cancer were used. Variables shown to be significant predictors of infection or adverse outcome in >1 CDR were analysed using multivariable logistic regression. Recalibration included re-evaluation of beta-coefficients (logistic model) or recursive-partition analysis (tree-based models).
findingsTwenty-five unique variables were identified across 17 FN CDRs. Fourteen were included in >1 CDR and 10 were analysed in our dataset. On univariate analysis, location, temperature, hypotension, rigors, severely unwell and decreasing platelets, white cell count, neutrophil count and monocyte count were significantly associated with bacterial infection. On multivariable analysis, decreasing platelets, increasing temperature and the appearance of being clinically unwell remained significantly associated. Five rules were recalibrated. Across all rules, recalibration increased the AUC-ROC and low-risk yield as compared to non-recalibrated data. For the SPOG-adverse event CDR, recalibration also increased sensitivity and specificity and external validation showed reproducibility.
interpretationDegree of marrow suppression (low platelets), features of inflammation (temperature) and clinical judgement (severely unwell) have been consistently shown to predict infection in children with FN. Recalibration of existing CDRs is a novel way to improve diagnostic performance of CDRs and maintain relevance over time.
fundingNational Health and Medical Research Council Grant (APP1104527).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.