A scoring system to predict superinfections in high-risk febrile neutropenic children with cancer

background. no scoring system has been published to date to assess the risk of superinfections (si) for high-risk children with febrile neutropenia (hrfn). methods. si diagnoses during or 1 week after initiating antibiotic therapy in hrfn children were evaluated. eight hundred and forty-nine episodes of febrile neutropenia (fn) were included in a prospective study to evaluate a scoring system designed to identify si. results. in the derivation set (566 episodes), 17% had si. a multivariate analysis identified the following significant si-related risk factors: acute lymphoblastic leukemia-acute myeloid leukemia (all-aml, or, 1.87; 95% ci, 1.13-3.10), central venous catheter (or, 2.11; 95% ci, 1.23-3.62), and febrile episode occurring within 10 days after chemotherapy (or, 1.86; 95% ci, 1.09-3.15). a si scoring system could be built: 1 point for all-aml, 1 point for the presence of a central venous catheter, and 1 point for the febrile episode occurring within 10 days after chemotherapy. if patients collected 3 points, then their risk of si was 25.8%. with 2 points the risk was 16.7%, and with one minimum score of 1 point, their risk was 10.9%. the sensitivity to predict ss was 100% and its negative predictive value (npv) was 100%. in the validation set (283 episodes), 49 (17%) children had si. for children with scores > 0, the scoring system yielded a sensitivity of 100%, and a npv of 100% for predicting si. conclusions. the use of a si score for hrfn patients was statistically validated by these results. a better initial predictive approach may allow improved therapeutic decisions for these children.