Risk stratification of pediatric febrile neutropenia (FN) is an established concept; the internal evaluation of a validated clinical decision rules (CDR) tool has not been well-described. In this study, restrictive criteria and procalcitonin were added to a recommended CDR for internal evaluation before implementation. Analysis of 577 FN episodes showed good sensitivity and negative predictive value in predicting blood stream infections (87.3%; 95.6%) and intensive care admissions (97.2%; 99.1%). There were no severe adverse events in low-risk patients with low procalcitonin; procalcitonin identified 3 low-risk patients with serious bacterial infections. The modified CDR with procalcitonin may assist in risk stratification.