Evaluation of risk stratification for predicting adverse outcomes in paediatric febrile neutropenia

Background: Adverse outcomes from febrile neutropenia (FN) are a common cause of morbidity and mortality in childhood cancer management. Outpatient management of individuals at low risk of adverse outcomes has been reported to reduce the cost of care, improve health-related quality of life (HRQL), and reduce the risk of hospital-acquired infections. Aim: To validate a tool for risk stratification of adverse outcomes in paediatric oncology patients at the Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. Setting: A retrospective data collection from 01 January 2017 to 31 December 2019 of children with a cancer diagnosis who had chemotherapy-induced febrile neutropenia. Methods: The study population comprised children with confirmed cancer diagnoses on chemotherapy with FN. Each episode of FN was evaluated. Results: Analysis was performed on 254 (99.2%) out of 256 oncology cases seen over the study period. In all, there were 267 chemotherapy-induced FN episodes in 179 patients. Ninety-nine (37.1%) adverse outcomes occurred in 267 FN episodes. Validation of a risk stratification tool of adverse outcome demonstrated a sensitivity and specificity of 52.3% and 62.0%, respectively. Positive and negative predictive values were 56.3% and 58.2%, respectively. The area under the curve translated to a 57.1% accuracy (p-value of 0.064). In our cohort, the coordinates of the curve’s best predictive values were between 7.5 and 8.5. Conclusion: A lower cut-off using the Swiss Paediatric Oncology Group (SPOG) FN risk index best predicted adverse outcomes in our cohort, although the tool could not be validated. Contribution: The SPOG FN tool is useful in our setting with easy accessibility of the parameters, however, a lower cut-off value is required to determine patients at risk of adverse events.