Abstract
BackgroundThere is no evidence-based definition of the temperature limit defining fever (TLDF) in children with neutropenia. Lowering the TLDF is known to increase the number of episodes of fever in neutropenia (FN). This study aimed to investigate the influence of a lower versus standard TLDF on diagnostics and therapy.MethodsIn a single pediatric cancer center using a high standard TLDF (39°C tympanic-temperature) patients were observed prospectively (NCT01683370). The effect of applying lower TLDFs (range 37.5°C to 38.9°C) versus 39.0°C on these measures was simulated in silicon.ResultsIn reality, 45 FN episodes were diagnosed. Of 3391 temperatures measured, 193 were ≥39.0°C, and 937 ≥38.0°C. For persisting fever ≥24 hours, additional blood cultures were taken in 31 (69%) episodes in reality. This number decreased to 22 (49%) when applying 39.0°C, and increased to 33 for 38.0°C (73%; plus 11 episodes; plus 24%). For persisting fever ≥48 hours, i.v.-antibiotics were escalated in 25 (56%) episodes. This number decreased to 15 (33%) when applying 39.0°C, and increased to 26 for 38.0°C (58%; plus 11 episodes; plus 24%). For persisting fever ≥120 hours, i.v.-antifungals were added in 4 (9%) episodes. This number increased to 6 (13%) by virtually applying 39.0°C, and to 11 for 38.0°C (24%; plus 5 episodes; plus 11%). The median length of stay was 5.7 days (range, 0.8 to 43.4). In 43 episodes with hospital discharge beyond 24 hours, applying 38.0°C led to discharge delay by ≥12 hours in 24 episodes (56%; 95% CI, 40 to 71), with a median delay of 13 hours, and a cumulative delay of 68 days.ConclusionApplying a low versus standard TLDF led to relevant increases of diagnostics, antimicrobial therapy, and length of stay. The differences between management in reality versus simply applying 39.0° as TLDF reflect the important impact of clinical assessment.
Highlights
In children with cancer, fever in chemotherapy-induced severe neutropenia (FN) is the most frequent potentially lethal complication and the leading cause of emergency hospitalization [1]
Applying a low versus standard temperature limit defining fever (TLDF) led to relevant increases of diagnostics, antimicrobial therapy, and length of stay
There is no international consensus on temperature-limits defining fever (TLDF) for children with chemotherapyinduced severe neutropenia, despite its relevance for the clinical diagnosis and management of fever in neutropenia (FN) [1,3,4]
Summary
Fever in chemotherapy-induced severe neutropenia (FN) is the most frequent potentially lethal complication and the leading cause of emergency hospitalization [1]. A review of the current literature shows a wide range of TLDF used clinically from 37.5 ̊C to 39.0 ̊C [5,6,7] Through this inconsistency between different centers, the diagnosis of FN is made at varying temperatures. At our center in Bern, with a historically established high TLDF of 39 ̊C ear-temperature, it has recently been shown that this high TLDF is efficacious in reducing the number of FN diagnosis and overtreatment. Lowering this limit would have led to additional FN diagnosis [7]. This study aimed to investigate the influence of a lower versus standard TLDF on diagnostics and therapy
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
