Variation in policies for the management of febrile neutropenia in United Kingdom Children's Cancer Study Group centres
Variation in policies for the management of febrile neutropenia in United Kingdom Children's Cancer Study Group centres
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DOI：
10.1136/adc.2006.102699
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发表时间：
2007-06-01
影响因子：
5.2
通讯作者：
Chisholm, Julia C.
中科院分区：
文献类型：
--
作者：
Phillips, Bob;Selwood, Karen;Chisholm, Julia C.
目的：评估目前英国治疗儿童发热性中性粒细胞减少症的管理策略的差异。设计和设置：对所有21个英国儿童癌症研究小组（UKCCSG）中心进行邮政调查，评估和整理与发热性中性粒细胞减少症管理有关的当地政策、协议或指南。进行了进一步的直接接触，以澄清任何不确定因素。结果：所有21个中心都提供了信息。在英国各地的中心，用于管理发热性中性粒细胞减少症的政策几乎在管理的每个方面都有所不同。发热的定义范围从持续温度> 37.5℃到单次读数> 39℃。中性粒细胞减少的定义不一致，中性粒细胞绝对计数< 1 × 10(9), < 0.75 × 10(9)或< 0.5 × 10(9)。每个方案中抗生素途径的选择，经验修改和抗葡萄球菌治疗是不同的。在11个中心使用了风险分层，其中6个中心在低风险病例中使用了降低强度治疗的政策。经验性抗真菌治疗的描述非常少，差异甚至更大。结论：在UKCCSG儿童癌症治疗中心，发热性中性粒细胞减少症的定义和治疗存在很大差异。由于当地微生物差异导致的一定程度的差异是可以预料的，但除此之外，我们应该寻求标准化我们定义发烧和中性粒细胞减少症、风险分层和经验治疗持续时间的方法的核心，以保持安全、最小化资源利用和最大化生活质量的方式。
Objective: To assess the variation in the current UK management strategies for the treatment of febrile neutropenia in childhood.Design and setting: A postal survey of all 21 United Kingdom Children's Cancer Study Group (UKCCSG) centres assessing and collating local policies, protocols or guidelines relating to the management of febrile neutropenia. Further direct contact was undertaken to clarify any uncertainties.Results: All 21 centres provided information. The policies used to manage febrile neutropenia in the centres around the UK vary in almost every aspect of management. Definitions of fever ranged from a persistent temperature of > 37.5 degrees C to a single reading of > 39 degrees C. Neutropenia was inconsistently defined as an absolute neutrophil count of < 1 x 10(9), < 0.75x10(9) or < 0.5x10(9). Choices of antibiotic approaches, empirical modifications and antistaphylococcal treatment were different in each protocol. The use of risk stratification was undertaken in 11 centres, with six using a policy of reduced intensity therapy in low risk cases. Empirical antifungal treatment was very poorly described and varied even more widely.Conclusions: There was a great deal of variation in definitions and treatment of febrile neutropenia in the UKCCSG children's cancer treatment centres. A degree of variation as a result of local microbiological differences is to be expected, but beyond this we should seek to standardise the core of our approach to defining fever and neutropenia, risk stratification and duration of empirical therapy in a way that maintains safety, minimises resource utilisation and maximises quality of life.