Esbenshade et al developed a model for predicting the presence of a blood stream infection in non-neutropenic child with cancer and fever. The authors are from Vanderbilt University, Monroe Carell Jr Children’s Hospital in Nashville, and UMC Utrect in The Netherlands.
Patient selection: pediatric patient (<= 26 years of age) with central venous catheter (CVC), fever and cancer, without neutropenia (absolute neutrophil count > 500 per µL)
Fever: temperature >= 38.3°C at any point or > 30°C for > 1 hour
Parameters:
(1) history of stem cell transplant (SCT)
(2) location at presentation
(3) type of central venous line
(4) hypotension
(5) chills and/or shaking rigors
(6) diagnosis ALL?
(7) drug exposure
(8) upper respiratory symptoms present
(9) age in years at time of first exposure
(10) height of temperature in °C (up to 40.6°C)
(11) absolute neutrophile count (up to 45,000 per µL)
(12) absolute monocyte count (up to 10,000 per µL)
|
Parameter |
Finding |
Points |
|
history of stem cell transplant |
no |
0 |
|
|
yes |
1.7 |
|
location at presentation |
inpatient |
0 |
|
|
outpatient |
22.9 |
|
type of central venous line |
port-a-cath |
0 |
|
|
PICC line |
34.2 |
|
|
Hickman catheter |
65.8 |
|
hypotension |
no |
0 |
|
|
yes |
28.4 |
|
chills and/or shaking rigors |
no |
0 |
|
|
yes |
18.5 |
|
diagnosis ALL? |
yes |
0 |
|
|
no |
27.4 |
|
drug exposure |
yes |
0 |
|
|
no |
63.7 |
|
upper respiratory symptoms |
yes |
0 |
|
|
no |
13 |
points for age =
= 48.75 – (1.875 * (age))
points for temperature =
= (26.885 * (temperature)) – 1021.616
points for absolute neutrophil count =
= 0.00166889 * (absolute neutrophil count)
points for absolute monocyte count =
= 100 – (0.01 * (absolute monocyte count))
total score =
= SUM(points for all 12 parameters)
Interpretation:
• minimum score: 0
• maximum score: 450
• The higher the score the greater the risk for a blood stream infection.
|
Parameter |
Percent of Patients with Blood Stream Infection |
|
< 293 |
< 10% |
|
293 to 347 |
(0.007429 * ((points)^2)) - (4.009 * (points)) + 546.9 |
|
347 to 402 |
(-0.005953 * ((points)^2)) + (5.18 * (points)) - 1033 |
|
> 402 |
> 90% |
Specialty: Infectious Diseases
ICD-10: ,
