Clinical Utility of the Paed‐ EQUAL Candida Score in Paediatric Candidemia: A Real‐World Cohort Study

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BACKGROUND: The Paed-EQUAL Candida Score was developed to assess adherence to guideline-recommended management in paediatric candidemia; however, its clinical utility in predicting outcomes remains unclear, particularly in paediatric populations where validation data are scarce. METHODS: We conducted a retrospective observational study including paediatric patients diagnosed with candidemia at a tertiary-care centre between 2014 and 2024. The Paed-EQUAL Candida Score was calculated for each patient, and its association with 30-day and 90-day mortality was evaluated using ROC curve analysis, and optimal cut-off values were explored. RESULTS: A total of 127 paediatric patients with candidemia were included, of whom 17 (13.4%) died within 30 days and 27 (21.3%) within 90 days. Central venous catheter removal was significantly associated with improved survival at both 30 days (76.4% vs. 35.3%, p = 0.001) and 90 days (77% vs. 48.1%, p = 0.007). Higher adherence to Paed-EQUAL Candida Score components was observed among survivors, with significantly higher median scores in survivors compared to non-survivors at 30 days (17 [IQR 14-18] vs. 14 [12-16], p = 0.026). However, the score indicated modest discriminative ability for predicting mortality, with an AUC of 0.667 (95% CI 0.577-0.748) for 30-day mortality and no significant predictive value for 90-day mortality (AUC 0.594, 95% CI 0.503-0.680). CONCLUSION: The Paed-EQUAL Candida Score demonstrated limited prognostic performance in paediatric candidemia and may have constraints in its ability to support clinical decision-making, particularly given its modest discriminative capacity. While it remains a potentially useful tool for assessing adherence to quality-of-care measures, further refinement or development of paediatric-specific and outcome-oriented scoring systems may be needed to improve risk stratification and prediction of clinical outcomes.