Prevalence and predictors of poor outcome in children with febrile neutropaenia presenting to the emergency department

Elliot Long^{1

2

3

4}, Franz E Babl^{1

2

3

4}, Natalie Phillips^{5

6}, Simon Craig^{2

7

8}, Michael Zhang⁹, Amit Kochar¹⁰, Mary McCaskill¹¹, Meredith L Borland^{12

13}, Monica A Slavin^{14

15

16

17

18}, Robert Phillips^{19

20}, Richard De A Lourenco²¹, Francoise Michinaud^{22

23}, Karin A Thursky^{14

15

16

17

18}, Gabrielle Haeusler^{14

15

16

17

24

25

26}; Australian PICNICC Study Group and the PREDICT Network

Affiliations

¹ Department of Emergency Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
² Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
³ Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
⁴ Centre for Integrated Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.
⁵ Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.
⁶ Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
⁷ Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.
⁸ Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.
⁹ Emergency Department, John Hunter Hospital, Newcastle, New South Wales, Australia.
¹⁰ Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia.
¹¹ Emergency Department, Sydney Children's Hospital, Sydney, New South Wales, Australia.
¹² Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.
¹³ Division of Paediatrics and Emergency Medicine, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.
¹⁴ Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
¹⁵ NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.
¹⁶ Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.
¹⁷ Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
¹⁸ Victorian Infectious Disease Service, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
¹⁹ Centre for Reviews and Dissemination, University of York, York, UK.
²⁰ Leed's Children's Hospital, Leeds General Infirmary, Leeds, UK.
²¹ Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia.
²² Children's Cancer Centre, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
²³ Unité d'Hématologie Immunologie Pédiatrique, Hôpital Robert-Debré, APHP Nord Université de Paris, Paris, France.
²⁴ Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
²⁵ NHMRC National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
²⁶ The Victorian Paediatric Integrated Cancer Service, Victorian State Government, Melbourne, Victoria, Australia.

PMID: 35419955
DOI: 10.1111/1742-6723.13978

Observational Study

Prevalence and predictors of poor outcome in children with febrile neutropaenia presenting to the emergency department

Elliot Long et al. Emerg Med Australas. 2022 Oct.

. 2022 Oct;34(5):786-793.

doi: 10.1111/1742-6723.13978. Epub 2022 Apr 13.

Authors

Affiliations

¹ Department of Emergency Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
² Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
³ Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
⁴ Centre for Integrated Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.
⁵ Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.
⁶ Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
⁷ Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.
⁸ Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.
⁹ Emergency Department, John Hunter Hospital, Newcastle, New South Wales, Australia.
¹⁰ Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia.
¹¹ Emergency Department, Sydney Children's Hospital, Sydney, New South Wales, Australia.
¹² Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.
¹³ Division of Paediatrics and Emergency Medicine, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.
¹⁴ Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
¹⁵ NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.
¹⁶ Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.
¹⁷ Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
¹⁸ Victorian Infectious Disease Service, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
¹⁹ Centre for Reviews and Dissemination, University of York, York, UK.
²⁰ Leed's Children's Hospital, Leeds General Infirmary, Leeds, UK.
²¹ Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia.
²² Children's Cancer Centre, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
²³ Unité d'Hématologie Immunologie Pédiatrique, Hôpital Robert-Debré, APHP Nord Université de Paris, Paris, France.
²⁴ Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
²⁵ NHMRC National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
²⁶ The Victorian Paediatric Integrated Cancer Service, Victorian State Government, Melbourne, Victoria, Australia.

PMID: 35419955
DOI: 10.1111/1742-6723.13978

Abstract

Objective: Children with acquired neutropaenia due to cancer chemotherapy are at high risk of severe infection. The present study aims to describe the prevalence and predictors of poor outcomes in children with febrile neutropaenia (FN).

Methods: This is a multicentre, prospective observational study in tertiary Australian EDs. Cancer patients with FN were included. Fever was defined as a single temperature ≥38°C, and neutropaenia was defined as an absolute neutrophil count <1000/mm³ . The primary outcome was the ICU admission for organ support therapy (inotropic support, mechanical ventilation, renal replacement therapy, extracorporeal life support). Secondary outcomes were: ICU admission, ICU length of stay (LOS) ≥3 days, proven or probable bacterial infection, hospital LOS ≥7 days and 28-day mortality. Initial vital signs, biomarkers (including lactate) and clinical sepsis scores, including Systemic Inflammatory Response Syndrome, quick Sequential Organ Failure Assessment and quick Paediatric Logistic Organ Dysfunction-2 were evaluated as predictors of poor outcomes.

Results: Between December 2016 and January 2018, 2124 episodes of fever in children with cancer were screened, 547 episodes in 334 children met inclusion criteria. Four episodes resulted in ICU admission for organ support therapy, nine episodes required ICU admission, ICU LOS was ≥3 days in four, hospital LOS was ≥7 days in 153 and two patients died within 28 days. Vital signs, blood tests and clinical sepsis scores, including Systemic Inflammatory Response Syndrome, quick Sequential Organ Failure Assessment and quick Paediatric Logistic Organ Dysfunction-2, performed poorly as predictors of these outcomes (area under the receiver operating characteristic curve <0.6).

Conclusions: Very few patients with FN required ICU-level care. Vital signs, biomarkers and clinical sepsis scores for the prediction of poor outcomes are of limited utility in children with FN.

Keywords: cancer; child; emergency service; febrile neutropaenia; multiple organ failure; sepsis.

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References

1. Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann. Intern. Med. 1966; 64: 328-40.
1. Lehrnbecher T, Robinson P, Fisher B et al. Guideline for the management of fever and neutropenia in children with cancer and hematopoietic stem-cell transplantation recipients: 2017 update. J. Clin. Oncol. 2017; 35: 2082-94.
1. Haeusler GM, Phillips R, Slavin MA et al. Re-evaluating and recalibrating predictors of bacterial infection in children with cancer and febrile neutropenia. EClinicalMedicine 2020; 23: 100394.
1. Haeusler GM, Thursky KA, Slavin MA et al. Risk stratification in children with cancer and febrile neutropenia: a national, prospective, multicentre validation of nine clinical decision rules. EClinicalMedicine 2020; 18: 100220.
1. Alexander SW, Wade KC, Hibberd PL, Parsons SK. Evaluation of risk prediction criteria for episodes of febrile neutropenia in children with cancer. J. Pediatr. Hematol. Oncol. 2002; 24: 38-42.

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Prevalence and predictors of poor outcome in children with febrile neutropaenia presenting to the emergency department

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Prevalence and predictors of poor outcome in children with febrile neutropaenia presenting to the emergency department

Authors

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Abstract

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Full Text Sources

Medical

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