{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T13:48:44Z","timestamp":1785332924882,"version":"3.55.0"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2023,8,2]],"date-time":"2023-08-02T00:00:00Z","timestamp":1690934400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004361","name":"Krebsliga Schweiz","doi-asserted-by":"publisher","award":["KLS-3645-02-2015"],"award-info":[{"award-number":["KLS-3645-02-2015"]}],"id":[{"id":"10.13039\/501100004361","id-type":"DOI","asserted-by":"publisher"}]},{"name":"the Berner Stiftung f\u00fcr krebskranke Kinder"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Fever in neutropenia (FN) remains a serious complication of childhood cancer therapy. Clinical decision rules (CDRs) are recommended to help distinguish between children at high and low risk of severe infection. The aim of this analysis was to develop new CDRs for three different outcomes and to externally validate published CDRs.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Procedure<\/jats:title>\n<jats:p>Children undergoing chemotherapy for cancer were observed in a prospective multicenter study. CDRs predicting low from high risk infection regarding three outcomes (bacteremia, serious medical complications (SMC), safety relevant events (SRE)) were developed from multivariable regression models. Their predictive performance was assessed by internal cross-validation. Published CDRs suitable for validation were identified by literature search. Parameters of predictive performance were compared to assess reproducibility.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>In 158 patients recruited between April 2016 and August 2018, 360 FN episodes were recorded, including 56 (16%) with bacteremia, 30 (8%) with SMC and 72 (20%) with SRE. The CDRs for bacteremia and SRE used four characteristics (type of malignancy, severely reduced general condition, leucocyte count &lt;0.3 G\/L, bone marrow involvement), the CDR for SMC two characteristics (severely reduced general condition and platelet count &lt;50 G\/L). Eleven published CDRs were analyzed. Six CDRs showed reproducibility, but only one in both sensitivity and specificity.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This analysis developed CDRs predicting bacteremia, SMC or SRE at presentation with FN. In addition, it identified six published CDRs that show some reproducibility. Validation of CDRs is fundamental to find the best balance between sensitivity and specificity, and will help to further improve management of FN.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0287233","type":"journal-article","created":{"date-parts":[[2023,8,2]],"date-time":"2023-08-02T17:37:44Z","timestamp":1690997864000},"page":"e0287233","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Outcome prediction in pediatric fever in neutropenia: Development of clinical decision rules and external validation of published rules based on data from the prospective multicenter SPOG 2015 FN definition study"],"prefix":"10.1371","volume":"18","author":[{"given":"Marina","family":"Santschi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland A.","family":"Ammann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp K. 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Report of a patient\/public involvement group","volume":"3","author":"B Phillips","year":"2019","journal-title":"BMJ Paediatr Open"},{"issue":"6","key":"pone.0287233.ref002","doi-asserted-by":"crossref","first-page":"2651","DOI":"10.1007\/s00520-016-3074-9","article-title":"Systematic review of reduced therapy regimens for children with low risk febrile neutropenia","volume":"24","author":"JE Morgan","year":"2016","journal-title":"Support Care Cancer"},{"issue":"3","key":"pone.0287233.ref003","first-page":"423","article-title":"First-day step-down to oral outpatient treatment versus continued standard treatment in children with cancer and low-risk fever in neutropenia","volume":"59","author":"E Brack","year":"2012","journal-title":"A randomized controlled trial within the multicenter SPOG 2003 FN study. 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