LAUSR

Febrile neutropenia (FN) is one of the most frequent complications of antineoplastic chemotherapy in children, with different incidences in acute leukaemia or solid tumours. In the early 600 of the last century the introduction of empirical antibacterial therapy reduced the high mortality associated with this condition, that nowadays is about 4% when antibiotic resistant pathogens are not involved [1]. Currently one of the most important goal in the management of FN is the identification of episodes with different risk of severe infections and/or complications, with the aim to personalize cure management: different antibiotic selections, possible early intensive care admission or early hospital discharge and/or full home-care approach. With this purposes, Haeusler et al. [2] compared the performance of 9 different clinical decision rules (CDR) using prospectively collected data during 858 episodes of FN in children with cancer by adopting a pragmatic, “real life” approach that for example included also repeated episodes of FN occurring in the same patient. Eight of these nine CRDs were reproducible, with similar sensitivity or specificity, but none of them was able to accurately differentiate high from low risk episodes. Interestingly, the performance of CDRs improved when the same parameters were re-evaluated on day 2, when the analysis included additional outcomes that become available, thus confirming the difficulties of getting “a priori” predictive indicators. Authors conclude that in the everyday clinical practice CDRs with highest sensitivity and negative-predictive value could be used for a home-based treatment of FN, while those with lower sensitivity could be used to select patients suitable for short in-hospital evaluation (12 48 h) before home discharge. If we further elaborate on this and apply the recommendations of the GRADE group for evaluation of diagnostic tests [3], we observe that the likelihood ratio of