发热中性粒细胞减少症（FN）仍然是儿童癌症治疗中严重的并发症。推荐使用临床决策规则（CDR）来帮助区分高风险和低风险患儿的严重感染情况。本分析的目的是开发新的CDR，用于三种不同的结果，并对已发表的CDR进行外部验证。在一个前瞻性多中心研究中观察到了接受癌症化疗的儿童。从多变量回归模型中开发了预测低风险和高风险感染的CDR，三个结果为菌血症、严重医疗并发症（SMC）和与安全相关的事件（SRE）。通过内部交叉验证评估了它们的预测性能。通过文献搜索确定了适合验证的已发表的CDR。比较了预测性能的参数以评估可重复性。 2016年4月至2018年8月，在158名患儿中招募了360个FN发作，其中包括菌血症56例（16%）、SMC 30例（8%）和SRE 72例（20%）。菌血症和SRE的CDR使用了四个特征（恶性肿瘤类型、严重的全身状况下降、白细胞计数<0.3 G/L、骨髓受累），SMC的CDR使用了两个特征（严重的全身状况下降和血小板计数<50 G/L）。分析了11个已发表的CDR，其中6个CDR显示可重复性，但只有一个在敏感性和特异性上均表现出可靠性。 本分析开发了针对FN发作时的菌血症、SMC或SRE的CDR。此外，还发现了六个已发表的具有一定可重复性的CDR。验证CDR对于找到敏感性和特异性之间的最佳平衡非常重要，将有助于进一步改进FN管理。 版权所有：© 2023 Santschi等。本文是以创作共享许可证发布的开放获取文章，该许可证允许在任何媒体中无限制使用、分发和复制，前提是原作者和来源保持不变。

Fever in neutropenia (FN) remains a serious complication of childhood cancer therapy. Clinical decision rules (CDRs) are recommended to help distinguish between children at high and low risk of severe infection. The aim of this analysis was to develop new CDRs for three different outcomes and to externally validate published CDRs.Children undergoing chemotherapy for cancer were observed in a prospective multicenter study. CDRs predicting low from high risk infection regarding three outcomes (bacteremia, serious medical complications (SMC), safety relevant events (SRE)) were developed from multivariable regression models. Their predictive performance was assessed by internal cross-validation. Published CDRs suitable for validation were identified by literature search. Parameters of predictive performance were compared to assess reproducibility.In 158 patients recruited between April 2016 and August 2018, 360 FN episodes were recorded, including 56 (16%) with bacteremia, 30 (8%) with SMC and 72 (20%) with SRE. The CDRs for bacteremia and SRE used four characteristics (type of malignancy, severely reduced general condition, leucocyte count <0.3 G/L, bone marrow involvement), the CDR for SMC two characteristics (severely reduced general condition and platelet count <50 G/L). Eleven published CDRs were analyzed. Six CDRs showed reproducibility, but only one in both sensitivity and specificity.This analysis developed CDRs predicting bacteremia, SMC or SRE at presentation with FN. In addition, it identified six published CDRs that show some reproducibility. Validation of CDRs is fundamental to find the best balance between sensitivity and specificity, and will help to further improve management of FN.Copyright: © 2023 Santschi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.