caa a22 4500 55528526X 20200410031629.0 cr unu---uuuuu 190206s2018 xx s 000 0 eng 1932-6203 10.1371/journal.pone.0193227 doi (BORIS)oai:boris.unibe.ch:123832 610 ddc 29462193 pmid The influence of different fever definitions on diagnostics and treatment after diagnosis of fever in chemotherapy-induced neutropenia in children with cancer [Elektronische Daten] [Stéphanie Wagner, Eva K Brack, Eveline Stutz-Grunder, Philipp Agyeman, Kurt Leibundgut, Marc Oliver Teuffel, Roland Ammann] publishedVersion openAccess eu-repo BACKGROUND There 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. METHODS In 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. RESULTS In 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. CONCLUSION Applying 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. Wagner Stéphanie joint author Brack Eva K. joint author Stutz-Grunder Eveline joint author Agyeman Philipp joint author Leibundgut Kurt joint author Teuffel Marc Oliver joint author Ammann Roland joint author PLoS ONE 13(2), e0193227 1932-6203 https://boris.unibe.ch/123832/1/2018.02%20085%20P1%20Orig%20Wagner%20FN%20Definition%20Bern%20FN.pdf text/html WWW-Backlink auf das Repository 1 info:eu-repo/semantics/article boris PeerReviewed boris peerstatus BORIS 856 40 https://boris.unibe.ch/123832/1/2018.02%20085%20P1%20Orig%20Wagner%20FN%20Definition%20Bern%20FN.pdf text/html WWW-Backlink auf das Repository BORIS 700 1- Wagner Stéphanie joint author BORIS 700 1- Brack Eva K. joint author BORIS 700 1- Stutz-Grunder Eveline joint author BORIS 700 1- Agyeman Philipp joint author BORIS 700 1- Leibundgut Kurt joint author BORIS 700 1- Teuffel Marc Oliver joint author BORIS 700 1- Ammann Roland joint author BORIS 773 0- PLoS ONE 13(2), e0193227 1932-6203 BK010053 XK010053 XK010000 BORIS BORIS BORIS info:eu-repo/semantics/article openAccess