A North American Survey of the Management Practice of Prolonged Pediatric Febrile Neutropenia
Bibliographic record
Abstract
Background: Febrile neutropenia (FN) is a common result of chemotherapy leading to life-threatening illness. The International Pediatric Fever and Neutropenia Guideline Panel issued guidelines in 2012 (updated in 2017) on the management of FN in children with cancer or recipients of hematopoietic stem cell transplants (HSCT) to provide guidance for management of prolonged FN. These guidelines recommend obtaining peripheral cultures at presentation (weak recommendation), initiating antipseudomonal monotherapy without modification except for changes in clinical status (strong recommendation), avoiding the use of empiric antifungal therapy except for patients with high risk of invasive fungal disease (strong recommendation), and not using galactomannan and β-D-glucan to evaluate for invasive fungal disease (weak recommendation and strong recommendation, respectively). The need for obtaining repeat blood cultures beyond 72 hours is unclear in pediatric FN, but recommended against in adult FN. Objectives: Determine physician management of FN on days 1, 4, 5, and 7 with fever in the setting of negative blood cultures, in patients with ALL (acute lymphoblastic leukemia), neuroblastoma (NB), and acute myeloid leukemia (AML) or HSCT. Design/Method: An electronic survey consisting of practice-pattern questions was sent to 1,631 pediatric hematologist/oncologists in the US and Canada. 162 complete responses were recorded for questions relating to ALL and neuroblastoma, 115 for AML, and 37 for HSCT. Results: 99.7% of respondents obtain ≥1 central venous catheter blood culture at presentation with 31% also obtaining peripheral blood cultures. Blood cultures on subsequent days of fever are obtained more frequently in the HSCT subgroup (96%) compared to the other groups (ALL (85%), p = 0.03; NB (87%), p = 0.022; and AML (89%), p = 0.044) and overall, more frequently in the AML/HSCT subgroup compared to ALL/NB (93% vs 86%; p = 0.03). 92% of respondents initiate empirical antipseudomonal monotherapy for ALL/NB patients compared to 43% for AML/HSCT patients (p = 0.002). The AML/HSCT subgroup is more likely to be treated with vancomycin compared to the ALL/NB subgroup both on presentation (54% vs 4%; p = 0.025) and overall (61% vs 28%; p = 0.004). Aminoglycoside use is less frequent, and used similarly in AML/HSCT patients as compared to ALL/NB patients (10% vs 7%; p = 0.12). For FN lasting ≥96 hours, 81% of physicians test for fungal disease, sending fungal cultures (56%), serum galactomannan (72%), and/or β-D-glucan (52%), and 76% initiating antifungal therapy. Conclusion: Physician practice deviates from pediatric specific guidelines for the management of FN. Further research is needed to understand the basis for these practice pattern differences.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.128 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".