Publications by authors named "Bob Phillips"

197 Publications

Optimising Antimicrobial Selection and Duration in the Treatment of Febrile Neutropenia in Children.

Infect Drug Resist 2021 30;14:1283-1293. Epub 2021 Mar 30.

Royal Marsden Hospital and Institute of Cancer Research, Sutton, SM2 5PT, UK.

Febrile neutropenia (FN) is a frequent complication of cancer treatment in children. Owing to the potential for overwhelming bacterial sepsis, the recognition and management of FN requires rapid implementation of evidenced-based management protocols. Treatment paradigms have progressed from hospitalisation with broad spectrum antibiotics for all patients, through to risk adapted approaches to management. Such risk adapted approaches aim to provide safe care through incorporating antimicrobial stewardship (AMS) principles such as implementation of comprehensive clinical pathways incorporating de-escalation strategies with the imperative to reduce hospital stay and antibiotic exposure where possible in order to improve patient experience, reduce costs and diminish the risk of nosocomial infection. This review summarises the principles of risk stratification in FN, the current key considerations for optimising empiric antimicrobial selection including knowledge of antimicrobial resistance patterns and emerging technologies for rapid diagnosis of specific infections and summarises existing evidence on time to treatment, investigations required and duration of treatment. To aid treating physicians we suggest the key features based on current evidence that should be part of any FN management guideline and highlight areas for future research. The focus is on treatment of bacterial infections although fungal and viral infections are also important in this patient group.
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http://dx.doi.org/10.2147/IDR.S238567DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019605PMC
March 2021

Towards evidence-based medicine for paediatricians.

Authors:
Bob Phillips

Arch Dis Child 2021 Apr;106(4):401

Centre for Reviews and Dissemination, University of York Alcuin College, York, UK

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http://dx.doi.org/10.1136/archdischild-2021-321930DOI Listing
April 2021

Olanzapine was an effective additional antiemetic for children and young people undergoing highly emetogenic chemotherapy.

Arch Dis Child Educ Pract Ed 2021 Mar 10. Epub 2021 Mar 10.

Centre for Reviews and Dissemination, University of York Alcuin College, York, UK.

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http://dx.doi.org/10.1136/archdischild-2021-321775DOI Listing
March 2021

UK paediatric oncology pneumonia surveillance study.

Arch Dis Child 2021 Feb 25. Epub 2021 Feb 25.

University of York Centre for Reviews and Dissemination, York, York, UK.

Background: pneumonia (PJP) is a serious infective complication of immunosuppressive therapy. There are insufficient data concerning the incidence or mortality rate in children undergoing treatment for malignancies and how these may be influenced by prophylaxis.

Objective: Prospective collection of clinical information for all suspected and proven cases of PJP in children with cancer in the UK and Ireland.

Design: A surveillance survey was undertaken using a key contact at each paediatric oncology Principle Treatment Centre (PTC).

Main Outcome Measures: To describe the mortality, outcomes and use of prophylaxis in this at-risk group.

Results: The study confirms that PJP is rare, with only 32 cases detected in the UK over a 2-year period reported from all 20 PTCs. No deaths were directly attributed to PJP, in contrast to previously reported high mortality rates. Breakthrough infection may occur despite prescription of ostensibly adequate prophylaxis with co-trimoxazole; 11 such cases were identified. Six infections occurred in patients for whom prophylaxis was not thought to be indicated. Two infections occurred in patients for whom prophylaxis was specifically omitted due to concerns about potential bone marrow suppression or delayed engraftment.

Conclusion: PJP in children treated for malignant disease is rare. Breakthrough infection despite prophylaxis with co-trimoxazole may represent pathogen resistance or non-compliance. Further consideration of the use of PJP prophylaxis during acute myeloid leukaemia and non-Hodgkin's lymphoma treatment is warranted, alongside appraisal of the clinical implications of the possible marrow suppressive effects of co-trimoxazole and its interactions with methotrexate.
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http://dx.doi.org/10.1136/archdischild-2020-319997DOI Listing
February 2021

Towards evidence-based medicine for paediatricians.

Authors:
Bob Phillips

Arch Dis Child 2021 Mar;106(3):301

Centre for Reviews and Dissemination, University of York Alcuin College, York, UK

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http://dx.doi.org/10.1136/archdischild-2021-321725DOI Listing
March 2021

External validation of clinical prediction models: simulation-based sample size calculations were more reliable than rules-of-thumb.

J Clin Epidemiol 2021 Feb 14;135:79-89. Epub 2021 Feb 14.

Centre for Prognosis Research, School of Medicine, Keele University, Keele, Staffordshire, United Kingdom.

Introduction: Sample size "rules-of-thumb" for external validation of clinical prediction models suggest at least 100 events and 100 non-events. Such blanket guidance is imprecise, and not specific to the model or validation setting. We investigate factors affecting precision of model performance estimates upon external validation, and propose a more tailored sample size approach.

Methods: Simulation of logistic regression prediction models to investigate factors associated with precision of performance estimates. Then, explanation and illustration of a simulation-based approach to calculate the minimum sample size required to precisely estimate a model's calibration, discrimination and clinical utility.

Results: Precision is affected by the model's linear predictor (LP) distribution, in addition to number of events and total sample size. Sample sizes of 100 (or even 200) events and non-events can give imprecise estimates, especially for calibration. The simulation-based calculation accounts for the LP distribution and (mis)calibration in the validation sample. Application identifies 2430 required participants (531 events) for external validation of a deep vein thrombosis diagnostic model.

Conclusion: Where researchers can anticipate the distribution of the model's LP (eg, based on development sample, or a pilot study), a simulation-based approach for calculating sample size for external validation offers more flexibility and reliability than rules-of-thumb.
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http://dx.doi.org/10.1016/j.jclinepi.2021.02.011DOI Listing
February 2021

Can low-dose dexamethasone be used instead of prednisolone in acute asthma attacks?

Arch Dis Child 2021 Feb 16. Epub 2021 Feb 16.

Centre for Reviews and Dissemination, University of York Alcuin College, York, UK.

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http://dx.doi.org/10.1136/archdischild-2020-320239DOI Listing
February 2021

Communication and ethical considerations for fertility preservation for patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group.

Lancet Oncol 2021 02;22(2):e68-e80

Division of Gynecology and Reproduction, Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.

Patients with childhood, adolescent, and young adult cancer who will be treated with gonadotoxic therapies are at increased risk for infertility. Many patients and their families desire biological children but effective communication about treatment-related infertility risk and procedures for fertility preservation does not always happen. The PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group reviewed the literature and developed a clinical practice guideline that provides recommendations for ongoing communication methods for fertility preservation for patients who were diagnosed with childhood, adolescent, and young adult cancer at age 25 years or younger and their families. Moreover, the guideline panel formulated considerations of the ethical implications that are associated with these procedures. Grading of Recommendations Assessment, Development and Evaluation methodology was used to grade the evidence and recommendations. In this clinical practice guideline, existing evidence and international expertise are combined to develop transparent recommendations that are easy to use to facilitate ongoing communication between health-care providers and patients with childhood, adolescent, and young adult cancer who might be at high risk for fertility impairment and their families.
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http://dx.doi.org/10.1016/S1470-2045(20)30595-7DOI Listing
February 2021

Towards evidence-based medicine for paediatricians.

Authors:
Bob Phillips

Arch Dis Child 2021 Feb;106(2):195

Centre for Reviews and Dissemination, University of York Alcuin College, York, UK

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http://dx.doi.org/10.1136/archdischild-2020-321441DOI Listing
February 2021

Towards evidence-based medicine for paediatricians.

Authors:
Bob Phillips

Arch Dis Child 2021 Jan;106(1):90

Centre for Reviews and Dissemination, University of York Alcuin College, York YO10 5DD, UK

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http://dx.doi.org/10.1136/archdischild-2020-321264DOI Listing
January 2021

Towards evidence-based medicine for paediatricians.

Authors:
Bob Phillips

Arch Dis Child 2020 Dec;105(12):1229

Centre for Reviews and Dissemination, University of York Alcuin College, York, UK

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http://dx.doi.org/10.1136/archdischild-2020-321049DOI Listing
December 2020

COVID-19 and children with cancer: Parents' experiences, anxieties and support needs.

Pediatr Blood Cancer 2021 02 21;68(2):e28790. Epub 2020 Nov 21.

Centre for Reviews and Dissemination, University of York, York, UK.

Background: Children with cancer were designated as clinically extremely vulnerable if they were to contract SARS-CoV-2 due to immune suppression in the early phase of the COVID-19 pandemic. Our aim was to explore experiences, information and support needs, and decision making of parents with a child with cancer in response to this phase in the United Kingdom.

Methods: Parents of a child with cancer completed a survey at a time when the UK moved into a period of 'lockdown'. An online survey was developed by the research team to capture parents' experiences, information and support needs, and decision making, using closed statements and open text boxes. Descriptive quantitative analyses and qualitative thematic content analysis were undertaken.

Findings: One hundred seventy-one parents/caregivers completed the survey. Eighty-five percent were worried about the virus and they were vigilant about the virus (92%) or cancer symptoms (93.4%). For two-thirds (69.6%), hospital was no longer considered a safe place. Eight overarching themes were identified related to the virus: (a) risk of infection; (b) information, guidance and advice; (c) health care provision; (d) fears and anxieties; or related to lockdown/isolation: (e) psychological and social impact; (f) keeping safe under lockdown; (g) provisions and dependence; and (h) employment and income.

Conclusions: This is the first study, to the best of our knowledge, to report experiences of parents of a child with cancer during the SARS-CoV-2/COVID-19 pandemic. The majority of parents were worried about SARS-CoV-2 and transmitting the virus to their child. Hospital was no longer perceived to be a safe place, and parents were worried about suboptimal cancer care. Parents described fear and anxiety and the psychological, social and economic impact of isolation.
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http://dx.doi.org/10.1002/pbc.28790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744834PMC
February 2021

Towards evidence-based medicine for paediatricians.

Authors:
Bob Phillips

Arch Dis Child 2020 Nov;105(11):1120

Centre for Reviews and Dissemination, Alcuin College, University of York, York, UK

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http://dx.doi.org/10.1136/archdischild-2020-320825DOI Listing
November 2020

Towards evidence-based medicine for paediatricians.

Authors:
Bob Phillips

Arch Dis Child 2020 Oct;105(10):1012

Centre for Reviews and Dissemination, University of York Alcuin College, York, UK

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http://dx.doi.org/10.1136/archdischild-2020-320543DOI Listing
October 2020

Conventional compared to network meta-analysis to evaluate antibiotic prophylaxis in patients with cancer and haematopoietic stem cell transplantation recipients.

BMJ Evid Based Med 2020 Aug 31. Epub 2020 Aug 31.

Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

Our purpose was to compare conventional meta-analysis and network meta-analysis to evaluate the efficacy of different prophylactic systemic antibiotic classes in patients undergoing chemotherapy or haematopoietic stem cell transplant (HSCT). We included randomised trials if patients had cancer or were HSCT recipients and the intervention was systemic antibacterial prophylaxis. Three types of control groups were used: (1) placebo, no antibiotic and non-absorbable antibiotic separately; (2) placebo and no antibiotic combined; and (3) all three combined. These gave different network geometries. Strategies synthesised were fluoroquinolone, trimethoprim-sulfamethoxazole, cephalosporin and parenteral glycopeptide versus control groups. In total 113 trials met the eligibility criteria. Where treatment effects could be estimated with both conventional and network meta-analysis, values were generally similar. However, where events were sparse, network meta-analysis could be more precise. For example, trimethoprim-sulfamethoxazole versus placebo for infection-related mortality showed a relative risk ratio (RR) of 0.55, 95% CI (0.21 to 1.44) with conventional, and RR 0.43, 95% credible region (0.20 to 0.82) with network meta-analysis. Cephalosporin versus fluoroquinolone was comparable only indirectly using the network approach and yielded RR 0.59, 95% credible region (0.28 to 1.20) to reduce bacteraemia. Incoherence (difference between direct and indirect estimates raising concerns about network meta-analysis validity) was observed with network geometry where control groups were separated, but not where control groups were combined. In this situation, conventional and network meta-analysis yielded similar results in general. Network meta-analysis results could be more precise when events were rare. Some analysis could only be performed with the network approach. These results identify scenarios in which network meta-analysis may be advantageous.
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http://dx.doi.org/10.1136/bmjebm-2020-111362DOI Listing
August 2020

Towards evidence-based medicine for paediatricians.

Authors:
Bob Phillips

Arch Dis Child 2020 Sep;105(9):903

Centre for Reviews and Dissemination, University of York Alcuin College, York, UK

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http://dx.doi.org/10.1136/archdischild-2020-320307DOI Listing
September 2020

Home-based care of low-risk febrile neutropenia in children-an implementation study in a tertiary paediatric hospital.

Support Care Cancer 2021 Mar 1;29(3):1609-1617. Epub 2020 Aug 1.

Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.

Background: Home-based management of low-risk febrile neutropenia (FN) is safe, improves quality of life and reduces healthcare expenditure. A formal low-risk paediatric program has not been implemented in Australia. We aimed to describe the implementation process and evaluate the clinical impact.

Method: This prospective study incorporated three phases: implementation, intervention and evaluation. A low-risk FN implementation toolkit was developed, including a care-pathway, patient information, home-based assessment and educational resources. The program had executive-level endorsement, a multidisciplinary committee and a nurse specialist. Children with cancer and low-risk FN were eligible to be transferred home with a nurse visiting daily after an overnight period of observation for intravenous antibiotics. Low-risk patients were identified using a validated decision rule, and suitability for home-based care was determined using disease, chemotherapy and patient-level criteria. Plan-Do-Study-Act methodology was used to evaluate clinical impact and safety.

Results: Over 18 months, 292 children with FN were screened: 132 (45%) were low-risk and 63 (22%) were transferred to home-based care. Compared with pre-implementation there was a significant reduction in in-hospital median LOS (4.0 to 1.5 days, p < 0.001) and 291 in-hospital bed days were saved. Eight (13%) patients needed readmission and there were no adverse outcomes. A key barrier was timely screening of all patients and program improvements, including utilising the electronic medical record for patient identification, are planned.

Conclusion: This program significantly reduces in-hospital LOS for children with low-risk FN. Ongoing evaluation will inform sustainability, identify areas for improvement and support national scale-up of the program.
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http://dx.doi.org/10.1007/s00520-020-05654-zDOI Listing
March 2021

Meta-analytic validation of new 'AUS' febrile neutropenia risk score.

Pediatr Blood Cancer 2021 01 25;68(1):e28580. Epub 2020 Jul 25.

Centre for Reviews and Dissemination, University of York, York, UK.

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http://dx.doi.org/10.1002/pbc.28580DOI Listing
January 2021

Towards evidence-based medicine for paediatricians.

Authors:
Bob Phillips

Arch Dis Child 2020 Aug;105(8):798

Centre for Reviews and Dissemination, University of York Alcuin College, York, UK

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http://dx.doi.org/10.1136/archdischild-2020-320035DOI Listing
August 2020

Towards evidence-based medicine for paediatricians.

Authors:
Bob Phillips

Arch Dis Child 2020 Jul;105(7):697

Centre for Reviews and Dissemination, University of York Alcuin College, York, UK

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http://dx.doi.org/10.1136/archdischild-2020-319732DOI Listing
July 2020

Clinical Practice Guideline for Systemic Antifungal Prophylaxis in Pediatric Patients With Cancer and Hematopoietic Stem-Cell Transplantation Recipients.

J Clin Oncol 2020 09 27;38(27):3205-3216. Epub 2020 May 27.

Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.

Purpose: To develop a clinical practice guideline for systemic antifungal prophylaxis in pediatric patients with cancer and hematopoietic stem-cell transplantation (HSCT) recipients.

Methods: Recommendations were developed by an international multidisciplinary panel that included a patient advocate. We conducted a systematic review of systemic antifungal prophylaxis in children and adults with cancer and HSCT recipients. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to make strong or weak recommendations and to classify level of evidence as high, moderate, low, or very low. The panel considered directness of the data to pediatric patients.

Results: There were 68 randomized trials included in the systematic review, of which 6 (9%) were conducted in a solely pediatric population. Strong recommendations were made to administer systemic antifungal prophylaxis to children and adolescents receiving treatment of acute myeloid leukemia, to those undergoing allogeneic HSCT pre-engraftment, and to those receiving systemic immunosuppression for graft-versus-host disease treatment. A strong recommendation was made to administer a mold-active agent with an echinocandin or a mold-active azole when systemic antifungal prophylaxis is warranted. For children younger than 13 years of age, an echinocandin, voriconazole, or itraconazole is suggested. Posaconazole may also be used in those age 13 years or older. A strong recommendation against routine administration of amphotericin as systemic antifungal prophylaxis was made.

Conclusion: We developed a clinical practice guideline for systemic antifungal prophylaxis administration in pediatric patients with cancer and HSCT recipients. Implementation and assessment of guideline-concordant rates and impacts are important future steps.
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http://dx.doi.org/10.1200/JCO.20.00158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499615PMC
September 2020

Towards evidence-based medicine for paediatricians.

Authors:
Bob Phillips

Arch Dis Child 2020 06;105(6):601

Centre for Reviews and Dissemination, University of York Alcuin College, York YO10 5NB, UK

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http://dx.doi.org/10.1136/archdischild-2020-319489DOI Listing
June 2020

Specialist paediatric palliative care for children and young people with cancer: A mixed-methods systematic review.

Palliat Med 2020 06 2;34(6):731-775. Epub 2020 May 2.

Department of Health Sciences, University of York, York, UK.

Background: Specialist paediatric palliative care services are promoted as an important component of palliative care provision, but there is uncertainty about their role for children with cancer.

Aim: To examine the impact of specialist paediatric palliative care for children and young people with cancer and explore factors affecting access.

Design: A mixed-methods systematic review and narrative synthesis (PROSPERO Registration No. CRD42017064874).

Data Sources: Database (CINAHL, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycINFO) searches (2000-2019) identified primary studies of any design exploring the impact of and/or factors affecting access to specialist paediatric palliative care. Study quality was assessed using The Mixed Methods Appraisal Tool.

Results: An evidence base of mainly low- and moderate-quality studies ( = 42) shows that accessing specialist paediatric palliative care is associated with less intensive care at the end of life, more advance care planning and fewer in-hospital deaths. Current evidence cannot tell us whether these services improve children's symptom burden or quality of life. Nine studies reporting provider or family views identified uncertainties about what specialist paediatric palliative care offers, concerns about involving a new team, association of palliative care with end of life and indecision about when to introduce palliative care as important barriers to access. There was evidence that children with haematological malignancies are less likely to access these services.

Conclusion: Current evidence suggests that children and young people with cancer receiving specialist palliative care are cared for differently. However, little is understood about children's views, and research is needed to determine whether specialist input improves quality of life.
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http://dx.doi.org/10.1177/0269216320908490DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243084PMC
June 2020

Towards evidence-based medicine for paediatricians.

Authors:
Bob Phillips

Arch Dis Child 2020 May;105(5):506

Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK

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http://dx.doi.org/10.1136/archdischild-2020-319198DOI Listing
May 2020

Towards evidence-based medicine for paediatricians.

Authors:
Bob Phillips

Arch Dis Child 2020 Apr;105(4):408

Centre for Reviews and Dissemination, University of York, York, UK

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http://dx.doi.org/10.1136/archdischild-2020-319050DOI Listing
April 2020

Baseline Chest Computed Tomography as Standard of Care in High-Risk Hematology Patients.

J Fungi (Basel) 2020 Mar 13;6(1). Epub 2020 Mar 13.

Department of Internal Medicine I, Bone Marrow Transplant-Unit, Medical University of Vienna, 1090 Vienna, Austria.

Baseline chest computed tomography (BCT) in high-risk hematology patients allows for the early diagnosis of invasive pulmonary aspergillosis (IPA). The distribution of BCT implementation in hematology departments and impact on outcome is unknown. A web-based questionnaire was designed. International scientific bodies were invited. The estimated numbers of annually treated hematology patients, chest imaging timepoints and techniques, IPA rates, and follow-up imaging were assessed. In total, 142 physicians from 43 countries participated. The specialties included infectious diseases ( = 69; 49%), hematology ( = 68; 48%), and others ( = 41; 29%). BCT was performed in 57% ( = 54) of 92 hospitals. Upon the diagnosis of malignancy or admission, 48% and 24% performed BCT, respectively, and X-ray was performed in 48% and 69%, respectively. BCT was more often used in hematopoietic cell transplantation and in relapsed acute leukemia. European centers performed BCT in 59% and non-European centers in 53%. Median estimated IPA rate was 8% and did not differ between BCT (9%; IQR 5-15%) and non-BCT centers (7%; IQR 5-10%) (p = 0.69). Follow-up computed tomography (CT) for IPA was performed in 98% ( = 90) of centers. In high-risk hematology patients, baseline CT is becoming a standard-of-care. Chest X-ray, while inferior, is still widely used. Randomized, controlled trials are needed to investigate the impact of BCT on patient outcome.
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http://dx.doi.org/10.3390/jof6010036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151030PMC
March 2020

Sensitivity of the Kaiser Permanente early-onset sepsis calculator: A systematic review and meta-analysis.

EClinicalMedicine 2020 Feb 22;19:100227. Epub 2019 Dec 22.

Centre for Reviews and Dissemination, University of York, Heslington YO10 5DD, UK.

Background: Determining which babies should receive antibiotics for potential early onset sepsis (EOS) is challenging. We performed a meta-analysis quantifying how many EOS cases might be 'missed' using the Kaiser Permanente electronic calculator, compared with National Institute for Health and Care Excellence (NICE) guidelines.

Methods: A systematic literature search was carried out for studies citing the article in which the calculator was publicised. Studies were eligible if they presented data evaluating the calculator, either by retrospective case review or prospective cohort study. The primary outcome measure was numbers of culture positive EOS cases where the calculator did not recommend empirical antibiotics, but NICE guidelines would have. Data were pooled using a random effect meta-analysis. A subgroup analysis was performed using data from studies of babies exposed to chorioamnionitis.

Findings: Eleven studies were included. There were a total of 75 EOS cases across the studies and a minimum of 14 (best case scenario), and a maximum of 22 (worst case scenario) cases where use of the calculator would have resulted in delayed or missed treatment, compared to if NICE guidelines had been followed. The probability of missed/delayed treatment for an EOS case were best case 0.19 [95% confidence intervals 0.11 - 0.29], worst case 0.31 [95% CI 0.17 - 0.49]. The probability of missing cases was significantly more in babies exposed to chorioamnionitis.

Interpretation: A large proportion of EOS cases were 'missed' by the calculator. Further evaluation of the calculator is recommended before it is introduced into UK clinical practice.

Funding: None.
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http://dx.doi.org/10.1016/j.eclinm.2019.11.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046522PMC
February 2020

Towards evidence-based medicine for paediatricians.

Authors:
Bob Phillips

Arch Dis Child 2020 Mar;105(3):304

Centre for Reviews and Dissemination, University of York, York, UK

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http://dx.doi.org/10.1136/archdischild-2020-318870DOI Listing
March 2020

Towards evidence-based medicine for paediatricians.

Authors:
Bob Phillips

Arch Dis Child 2020 Feb 13;105(2):200. Epub 2020 Jan 13.

Centre for Reviews and Dissemination, University of York, York, UK

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http://dx.doi.org/10.1136/archdischild-2019-318691DOI Listing
February 2020

Towards evidence-based medicine for paediatricians.

Authors:
Bob Phillips

Arch Dis Child 2020 Jan;105(1):96

Centre for Reviews and Dissemination, University of York, York, UK

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http://dx.doi.org/10.1136/archdischild-2019-318586DOI Listing
January 2020