Different fever definitions and the rate of fever and neutropenia diagnosed in children with cancer: A retrospective two‐center cohort study

Abstract

BACKGROUND: The definition of fever, and thus fever and neutropenia (FN), varies between different pediatric oncology centers. Higher temperature limit should reduce FN rates, but may increase rates of FN with complications by delaying therapy. This study determined if different fever definitions are associated with different FN rates. PROCEDURE: Two pediatric oncology centers had used three 39 [0.53-3.62]; P = 0.50). CONCLUSION: A higher fever definition was not associated with a lower FN rate, nor with an increased rate of FN with bacteremia. These may be false negative findings due to methodological limitations. These questions, with their potential impact on health-related quality of life, and on costs, need to be assessed in prospective studies. Pediatr Blood Cancer

Management of fever and neutropenia in children with cancer: A survey of Australian and New Zealand practice

“…This variability is not surprising as a consensus fever definition could not be achieved by an international panel of FN experts . Few studies have explored the clinical impact of different fever definitions, with one study concluding that a higher temperature definition was not associated with a lower FN rate or with an increased rate of bacteraemia . Regarding the use of biomarkers in the assessment of FN, CRP continues to be the most frequently used despite underwhelming evidence of its ability to accurately predict infection or adverse outcome .…”

“…24 Few studies have explored the clinical impact of different fever definitions, with one study concluding that a higher temperature definition was not associated with a lower FN rate or with an increased rate of bacteraemia. 25 Regarding the use of biomarkers in the assessment of FN, CRP continues to be the most frequently used despite underwhelming evidence of its ability to accurately predict infection or adverse outcome. 26 Further translational research is required to identify novel biomarkers that can assist in risk stratification and guide antibiotic duration.…”

The Influence of Different Fever Definitions on the Rate of Fever in Neutropenia Diagnosed in Children with Cancer

“…Despite its clinical importance, however, fever and thus FN are not consistently defined in pediatric oncology. A widely used fever definition, specifically, temperature limits defining fever (TLDF), encompasses a persistent temperature ≥38.0°C, or a single temperature ≥38.3°C [ 2 ] or ≥38.5°C [ 3 ], but definitions used clinically and in research range from 37.5°C to 39.0°C [ 3 – 6 ]. This wide range reflects that both an international consensus on TLDF is missing [ 7 ], and that national consensus-based policies are incompletely implemented locally [ 3 , 8 ].…”

“…A high TLDF emphasizes efficacy by avoiding unnecessary FN diagnoses in patients without relevant infections who will spontaneously defervesce ( Fig. 1 ) [ 6 ]. A low TLDF emphasizes safety by avoiding delays in FN diagnosis and start of empirical antimicrobial therapy.…”

“…To our knowledge, there is no published or ongoing prospective study on the efficacy or safety of different TLDFs in pediatric or adult oncology. A single Swiss two-center retrospective study reported no significant difference in the rate of FN, and of FN with bacteremia, between temperature limits of 38.5°C and 39.0°C [ 6 ].…”