Discrepancies between national and local guidelines for the management of paediatric oncology patients with fever and neutropenia (FN): A need for alignment?

Abstract

BackgroundWe previously demonstrated in a large multicentre point prevalence study (PPS) a marked variability across German and Austrian centres regarding the management of fever and neutropenia (FN) in children, and a high rate of inappropriate treatments compared to recommendations in the German national FN guidelines. MethodsWe analysed local FN standard operating procedures (SOPs) of participating centres and rated their concordance with the German national FN guidelines. To this end, we defined items derived from the German national FN guidelines that we considered essential for any local FN SOP, and assigned points per items. The items comprised “basic requirements of a SOP”; “risk analysis”; “diagnostic approach”; and “use of antibiotics including dosing recommendations”, including sub-categories. ResultsOf the 30 participating centres’ SOPs, 29 were of sufficient granularity for detailed analysis. Only 19/29 (66%) and 20/29 (69%) of the SOPs provided a definition of fever and of neutropenia, respectively. The top scoring sub-categories were “empiric treatment” (mean percentage 69%), “laboratory investigations” (62.4%), and “SOP basics” (59.7%). The worst scoring sub-categories were “definitions” (37.7%), “risk analysis” (32.3%), and “outpatient treatment” (15.7%). ConclusionsThe majority of the local FN SOPs demonstrated a lack of concordance with the German national guidelines on the management of paediatric FN. These discrepancies may explain the high rate of inappropriate antimicrobial treatments in our previous PPS. Our data indicate that local SOPs should be better adapted to national guidelines, and national guidelines should be conceived with the feedback of end-users, thereby anticipating barriers and facilitating acceptance.