{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T20:41:05Z","timestamp":1788381665752,"version":"build-2803163510"},"reference-count":17,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,8,28]],"date-time":"2022-08-28T00:00:00Z","timestamp":1661644800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Fever and infection are an important complication of childhood cancer therapy. Most research and guideline development has focussed on febrile neutropenia, with a paucity directed at non\u2010neutropenic fever (NNF). We describe the clinical presentation, management and outcomes of NNF in children with cancer, and externally validate the Esbenshade Vanderbilt (EsVan) clinical decision rules (CDR) to predict bacteraemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      Using a prospective database, retrospective data were collected on consecutive NNF episodes (fever \u226538.0\u00b0C and absolute neutrophil count &gt;1.0\u00a0cells\/mm\n                      <jats:sup>3<\/jats:sup>\n                      ). Sensitivity, specificity and area under the receiver operator characteristic curve (AUC\u2010ROC) of the CDR were compared to derivation study.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 203 NNF episodes occurring in 125 patients. Severe sepsis was uncommon (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a02, 1%) and bacteraemia occurred in 10 (4.9%, 95% confidence interval [CI]: 2.7%\u20138.8%) episodes. A confirmed or presumed bacterial infection requiring antibiotics occurred in 31 (15%) patients. Total 202 (99%) episodes received at least one dose of intravenous broad\u2010spectrum antibiotic and 141 (70%) episodes were admitted to hospital. Six (3%) episodes required intensive care unit (ICU)\u2010level care and there were no infection\u2010related deaths. The EsVan 1 rule had an AUC\u2010ROC of 0.67, 80% were identified as low risk, and sensitivity and specificity were 50% and 81.5%, respectively, for a risk threshold of 10%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Serious infection and adverse outcome are uncommon in children with NNF. Many children did not have a bacterial cause of infection identified, but were still treated with broad\u2010spectrum antibiotics and admitted to hospital. National clinical practice guidelines should be developed for this important cohort to enable risk stratification and optimise antibiotic management. Further research is required to determine appropriateness of EsVan CDR in our cohort.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pbc.29931","type":"journal-article","created":{"date-parts":[[2022,8,29]],"date-time":"2022-08-29T00:29:02Z","timestamp":1661732942000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Non\u2010neutropenic fever in children with cancer: Management, outcomes and clinical decision rule validation"],"prefix":"10.1002","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3851-7502","authenticated-orcid":false,"given":"Hannah","family":"Walker","sequence":"first","affiliation":[{"name":"The Children's Cancer Centre The Royal Children's Hospital Parkville  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam J.","family":"Esbenshade","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Vanderbilt University Medical Centre  Nashville Tennessee USA"},{"name":"Vanderbilt Ingram Cancer Centre  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Dale","sequence":"additional","affiliation":[{"name":"The Children's Cancer Centre The Royal Children's Hospital Parkville  Parkville Victoria Australia"},{"name":"The Children's Cancer Centre Monash Children's Hospital  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanika","family":"Bhatia","sequence":"additional","affiliation":[{"name":"The Children's Cancer Centre The Royal Children's Hospital Parkville  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiguo","family":"Zhao","sequence":"additional","affiliation":[{"name":"Vanderbilt Ingram Cancer Centre  Nashville Tennessee USA"},{"name":"Department of Biostatistics Vanderbilt University Medical Centre  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franz E.","family":"Babl","sequence":"additional","affiliation":[{"name":"Emergency Department The Royal Children's Hospital Parkville  Parkville Victoria Australia"},{"name":"Clinical Sciences Murdoch Children's Research Institute  Parkville Victoria Australia"},{"name":"Department of Paediatrics and Critical Care University of Melbourne  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2344-1365","authenticated-orcid":false,"given":"Rachel","family":"Conyers","sequence":"additional","affiliation":[{"name":"The Children's Cancer Centre The Royal Children's Hospital Parkville  Parkville Victoria Australia"},{"name":"Department of Paediatrics and Critical Care University of Melbourne  Parkville Victoria Australia"},{"name":"Cardiac Regeneration Murdoch Children's Research Institute  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle M.","family":"Haeusler","sequence":"additional","affiliation":[{"name":"Clinical Sciences Murdoch Children's Research Institute  Parkville Victoria Australia"},{"name":"Department of Paediatrics and Critical Care University of Melbourne  Parkville Victoria Australia"},{"name":"The Paediatric Integrated Cancer Service  Parkville Victoria Australia"},{"name":"Department of Infectious Diseases Peter MacCallum Cancer Centre  Melbourne Victoria Australia"},{"name":"Department of Infectious Diseases Royal Children's Hospital  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,8,28]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0000000000000208"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2017.154"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2010.05.024"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27634"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2019.11.013"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25275"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.00591"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25335"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PCC.0000149131.72248.E6"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.5847\/wjem.j.1920-8642.2015.02.002"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-020324"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30792"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.47.5905"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-020-05654-z"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.29469"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2009.12.980"}],"container-title":["Pediatric 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