Guideline for the Management of Fever and Neutropenia in Children With Cancer and/or Undergoing Hematopoietic Stem-Cell Transplantation
Guideline for the Management of Fever and Neutropenia in Children With Cancer and/or Undergoing Hematopoietic Stem-Cell Transplantation
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DOI：
10.1200/jco.2012.42.7161
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发表时间：
2012-12-10
影响因子：
45.3
通讯作者：
Sung, Lillian
中科院分区：
文献类型：
--
作者：
Lehrnbecher, Thomas;Phillips, Robert;Sung, Lillian
目的为儿科发热和中性粒细胞减少症(FN)的经验性处理制定循证指南。方法国际儿科发热和中性粒细胞减少症指南小组是一个由儿科肿瘤学和传染病专家以及患者权益倡导者组成的多学科多国小组。该小组的召开是为了制定这一准则。我们遵循先前经过验证的创建循证指南的程序。工作组将重点放在初始陈述、持续管理和经验性抗真菌治疗上。每个工作组都提出了关键的临床问题，对已发表的文献进行了系统的审查，并汇编了证据摘要。使用推荐评估、发展和评估方法生成摘要，并根据方法学考虑将证据分类为高、中、低或极低。结果提出了与儿童FN的初始表现(风险分层、初始评估和治疗)、持续管理(修改和停用经验性抗生素)和经验性抗真菌治疗(风险分层、评估和治疗)相关的建议。对于每个建议，建议的强度和证据水平都被提出。结论该指南代表了一种针对癌症儿童FN的循证方法。尽管一些建议类似于成人指南，但在多个领域有关键的区别。执行工作将需要适应当地的情况。J Clin Oncol30：4427-4438。(C)2012年美国临床肿瘤学会
PurposeTo develop an evidence-based guideline for the empiric management of pediatric fever and neutropenia (FN).MethodsThe International Pediatric Fever and Neutropenia Guideline Panel is a multidisciplinary and multinational group composed of experts in pediatric oncology and infectious disease as well as a patient advocate. The Panel was convened for the purpose of creating this guideline. We followed previously validated procedures for creating evidence-based guidelines. Working groups focused on initial presentation, ongoing management, and empiric antifungal therapy. Each working group developed key clinical questions, conducted systematic reviews of the published literature, and compiled evidence summaries. The Grades of Recommendation Assessment, Development, and Evaluation approach was used to generate summaries, and evidence was classified as high, moderate, low, or very low based on methodologic considerations.ResultsRecommendations were made related to initial presentation (risk stratification, initial evaluation, and treatment), ongoing management (modification and cessation of empiric antibiotics), and empiric antifungal treatment (risk stratification, evaluation, and treatment) of pediatric FN. For each recommendation, the strength of the recommendation and level of evidence are presented.ConclusionThis guideline represents an evidence-based approach to FN specific to children with cancer. Although some recommendations are similar to adult-based guidelines, there are key distinctions in multiple areas. Implementation will require adaptation to the local context. J Clin Oncol 30:4427-4438. (c) 2012 by American Society of Clinical Oncology