Conflict of interest: Nothing to declare.
Which decision rules meet methodological standards in children with febrile neutropenia? Results of a systematic review and analysis
Article first published online: 29 JUN 2014
© 2014 Wiley Periodicals, Inc.
Pediatric Blood & Cancer
Volume 61, Issue 10, pages 1786–1791, October 2014
How to Cite
Delebarre, M., Macher, E., Mazingue, F., Martinot, A. and Dubos, F. (2014), Which decision rules meet methodological standards in children with febrile neutropenia? Results of a systematic review and analysis. Pediatr. Blood Cancer, 61: 1786–1791. doi: 10.1002/pbc.25106
- Issue published online: 19 AUG 2014
- Article first published online: 29 JUN 2014
- Manuscript Accepted: 23 APR 2014
- Manuscript Received: 16 JAN 2014
- decision rules;
Clinical decision rules (CDRs) have sought to identify the few children with chemotherapy-induced febrile neutropenia (FN) really at risk of severe infection to reduce the invasive procedures and costs for those at low risk. Several reports have shown that most rules do not perform well enough to be clinically useful. Our objective was to analyze the derivation methods and validation procedures of these CDRs.
A systematic review using Medline, Ovid, Refdoc, and the Cochrane Library through December 2012 searched for all CDRs predicting the risk of severe infection and/or complications in children with chemotherapy-induced FN. Their methodological quality was analyzed by 17 criteria for deriving and validating a CDR identified in the literature. The criteria published by the Evidence Based Medicine Working Group were applied to the published validations of each CDR to assess their level of evidence.
The systematic research identified 612 articles and retained 12 that derived CDRs. Overall, the CDRs met a median of 65% of the methodological criteria. The criteria met least often were that the rule made clinical sense, or described the course of action, or that the variables and the CDR were reproducible. Only one CDR, developed in South America, met all methodological criteria and provided the highest level of evidence; unfortunately it was not reproducible in Europe.
Only one CDR developed for children with FN met all methodological standards and reached the highest level of evidence. Pediatr Blood Cancer 2014; 61:1786–1791. © 2014 Wiley Periodicals, Inc.