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Internal evaluation of risk stratification tool using procalcitonin and clinical risk factors in pediatric febrile neutropenia: the first step in a pilot quality improvement project
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  • Charles Nessle,
  • Thomas Braun,
  • Sung Won Choi,
  • Rajen Mody
Charles Nessle
University of Michigan Medical School

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Thomas Braun
University of Michigan School of Public Health
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Sung Won Choi
University of Michigan Michigan Medicine
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Rajen Mody
University of Michigan
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Risk stratification of pediatric febrile neutropenia (FN) is an established concept; the internal evaluation of a validated clinical decision rules (CDR) tool has not been well-described. In this study, restrictive criteria and procalcitonin were added to a recommended CDR for internal evaluation before implementation. Analysis of 577 FN episodes showed good sensitivity and negative predictive value in predicting blood stream infections (87.3%; 95.6%) and intensive care admissions (97.2%; 99.1%). There were no severe adverse events in low-risk patients with low procalcitonin; procalcitonin identified 3 low-risk patients with serious bacterial infections. The modified CDR with procalcitonin may assist in risk stratification.