Comparative Content Analysis of Pediatric Febrile Neutropenia Clinical Practice Guideline Stratified by Language
Brandon Fickling, Asher Hancock, Tea Reljic, Sergio Licona, Vivian Moreno Berrio, Ambuj Kumar, Sheena MukkadaAbstract
Background
The prevalence of pediatric febrile neutropenia (FN) is about 34% and associated with significant resource use. The management of FN differs across global settings. Standardization of FN management may be beneficial for resource planning and establishment of best practice. This comparative analysis aims to systematically assess the content of Clinical Practice Guidelines (CPG) recommendations for the management of pediatric FN in English versus non-English languages and their agreement with international recommendations.
Methods
A literature search was performed through PubMed, Embase, and Web of Science databases using standardized search terms. Any evidence-based CPG with recommendations for the management of pediatric FN patients was eligible for inclusion. Recommendations were extracted from CPGs and categorized by language (English and non-English language), management domain (diagnostic, prognostic or treatment) and the direction (in favor or against) CPGs. Analysis was performed using the Chi-squared test to assess the domains, direction of recommendations, and agreement with the Adapted Resource and Implementation Application (ARIA) Clinical Practice Recommendations (CPR) for Fever and Neutropenia, a comprehensive resource-adapted guideline.
Results
The initial search yielded 573 citations, of which fourteen CPGs met the inclusion criteria. Ten CPGs were in English and four in non-English languages (Spanish: n=3, German n=1). The median number of recommendations for English CPGs was 19.5 (range: 2-30) and 69.5 (range: 28-107) for non-English CPGs. Methodology was specified in 70% (7/10) of English CPGs compared to 100% (4/4) of non-English CPGs. There was a significant difference between English versus non-English CPGs for FN management domains (p=0.003), direction of the recommendation (p=0.005), and recommendation agreement with ARIA CPR (p<0.001). The detailed results are presented in Table 1.
Conclusions
The results from our study shows significant variability in the coverage of management content, recommendation’s direction, and recommendation’s agreement with ARIA CPR among English versus non-English CPGs. These findings demonstrate the importance of using both English and non-English language guidelines to inform harmonized practices for management of pediatric FN.