Value of electronic data for model validation and refinement: Bacteremia risk in children with fever and neutropenia

Kristine Madsen, Marc Rosenman, Siu Hui, Philip P. Breitfeld

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background: Validating published risk models in a different time and setting can be a labor-intensive process. Data in electronic format provide the potential to test the validity of risk models without labor-intensive chart reviews and data capture. The authors attempted to use readily available electronic data to find appropriate cases and to validate and refine a previously developed risk model for predicting bacteremia in children with cancer who had fever and neutropenia. Patients and Methods: By applying a largely automated case-finding algorithm to linked, electronic clinical and administrative data systems, the authors identified and acquired data regarding 157 episodes of fever and neutropenia in children with cancer admitted to a children's hospital during an 11-month period in 1997. The authors applied a previously developed and validated risk model for bacteremia to this 1997 cohort by assessing the odds ratios among risk groups. The model assigns encounters with absolute monocyte count of 100 cells or more/mm3 to a low-risk group and encounters with an absolute monocyte count of less than 100 cells/mm3 to intermediate-risk (temperature 10/mm3), intermediate risk (temperature ≤39.5°C and absolute monocyte count ≤10/mm3), and high risk (temperature >39.5°C). Conclusions: Existing electronic data provide an efficient means for case-finding and model validation and refinement. The previously developed bacteremia model had good but not optimal predictive performance in the new data set. Admission absolute monocyte count and temperature remain significant risk factors for bacteremia. Redefining the risk categories, including a much lower cutpoint for admission absolute monocyte count, improved the model's discrimination, which suggests that predictive models need periodic updating.

Original languageEnglish (US)
Pages (from-to)256-262
Number of pages7
JournalJournal of Pediatric Hematology/Oncology
Volume24
Issue number4
DOIs
StatePublished - 2002
Externally publishedYes

Fingerprint

Bacteremia
Neutropenia
Fever
Monocytes
Temperature
Sensitivity Training Groups
Information Systems
Neoplasms
Cell Count
Odds Ratio

Keywords

  • Bacteremia
  • Cancer
  • Children
  • Fever
  • Neutropenia
  • Risk models

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Oncology
  • Hematology

Cite this

Value of electronic data for model validation and refinement : Bacteremia risk in children with fever and neutropenia. / Madsen, Kristine; Rosenman, Marc; Hui, Siu; Breitfeld, Philip P.

In: Journal of Pediatric Hematology/Oncology, Vol. 24, No. 4, 2002, p. 256-262.

Research output: Contribution to journalArticle

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