Pediatric Critical Care Medicine Fellow Phoenix Children's Hospital Phoenix, Arizona, United States
Background: Studies in immunocompromised children have demonstrated that bronchoscopy with bronchoalveolar lavage (BAL) can identify pathogens and influence antimicrobial therapy in up to 43% and 53% of cases, respectively. However, the ranges of reported impact on clinical management are highly variable. How BAL impacts the management of pediatric oncology patients with febrile neutropenia is poorly understood. There are no current guidelines regarding the use of BAL for therapeutic or diagnostic purposes in these patients. Understanding how BAL impacts accurate microbiological diagnosis and antimicrobial therapy is crucial to developing future evidence-based guidelines and decreasing antimicrobial use in pediatric oncology patients admitted with febrile neutropenia. Objective: The primary objective of this study is to quantify the frequency of pathogen identification and changes in antimicrobial therapy as the result of bronchoscopy with BAL in pediatric oncology patients with febrile neutropenia. Secondary objectives include describing complications and their frequency related to bronchoscopy with BAL and identifying common characteristics in patients in which bronchoscopy with BAL impacts clinical management. Design/Methods: This is a single center retrospective observational study that will utilize chart review of pediatric oncology patients admitted with febrile neutropenia and who underwent bronchoscopy with BAL at our institution over a 10-year period. This study was approved by our institutional review board. Data collection and analysis is expected to be complete by February 2025. Data will be summarized as mean (SD) or median (IQR) for continuous variables and frequency (percent) for categorical variables. Estimates of mean and rates will be computed along with corresponding 95% confidence intervals. Exploratory analyses will evaluate association between clinical characteristics with BAL findings using parametric or non-parametric analyses, as appropriate for the data distribution. All statistical tests will be 2-sided with significance evaluated at the 5% level.
