Internal evaluation of risk stratification tool using serial procalcitonin and clinical risk factors in pediatric febrile neutropenia: The non-interventional, single institution experience prior to clinical implementation.
Internal evaluation of risk stratification tool using serial procalcitonin and clinical risk factors in pediatric febrile neutropenia: The non-interventional, single institution experience prior to clinical implementation.
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DOI：
10.1080/08880018.2022.2079785
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发表时间：
2023-03
影响因子：
1.7
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中科院分区：
文献类型：
--
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儿童发热性中性粒细胞减少症（FN）的风险分层是一个既定的概念，但临床风险工具错误分类了近5%的临床标准风险事件与严重的结果。尚未充分描述临床风险工具实施前的内部评估。在这项非干预性队列研究中，我们评估了研究决策规则（SDR）工具;一种连续降钙素原的临床风险工具。研究标准风险（SSR）组符合临床标准风险标准，两个连续降钙素原<0.4 ng/mL。研究高风险（SHR）组符合临床高风险标准或临床标准风险，降钙素原≥0.4 ng/mL。描述性和双变量统计比较组和结果。仅临床标准就确定了39.1%（238/608）的标准风险事件; 5.9%（14/238）发生重度事件。前瞻性使用SDR，SHR组包括76.6%（92/120）的发作;由于降钙素原升高≥0.4 ng/mL，20%（3/15）的标准风险发作发生重度事件。SHR组的血流感染[21.7%（20/92）vs. 0%（0/28）; P = 0.007]和重症监护入院[13%（12/92）vs. 3.6%（1/28）; P = 0.158]更多。总之，连续降钙素原SDR有助于识别临床标准风险事件中的重度事件，但分析有限。在FN发作风险分层之前，机构可以考虑类似的内部评估方法。
Risk stratification of pediatric febrile neutropenia (FN) is an established concept, yet clinical risk tools misclassify nearly 5% of clinical standard-risk episodes with severe outcomes. the internal evaluation of a clinical risk tool before implementation has not been well-described. In this noninterventional cohort study, we evaluated a study decision rules (SDR) tool; a clinical risk tool with serial procalcitonin. the study standard-risk (SSR) group met clinical standard-risk criteria with two serial procalcitonin <0.4 ng/mL. the study high-risk (SHR) group met clinical high-risk criteria or clinical standard-risk with a procalcitonin ≥0.4 ng/mL. Descriptive and bivariate statistics compared the groups and outcomes. Clinical criteria alone identified 39.1% (238/608) standard-risk episodes; 5.9% (14/238) had severe events. prospectively using the SDR, the SHR group encompassed 76.6% (92/120) of episodes; severe events occurred in 20% (3/15) of standard-risk episodes included due to elevated procalcitonin ≥0.4 ng/mL. the SHR group had more blood stream infections [21.7% (20/92) vs. 0% (0/28); P = 0.007] and intensive care admissions [13% (12/92) vs. 3.6% (1/28); P = 0.158]. In conclusion, the SDR with serial procalcitonin aided in identifying severe events in clinical standard-risk episodes, but analysis was limited. Institutions may consider similar internal evaluation methodology before FN episode risk stratification.
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