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    Emergency ambulatory management of low-risk febrile neutropenia: multinational association for supportive care in cancer fits-real-world experience from a UK cancer center

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    Authors
    Marshall, William
    Campbell, Geraldine
    Knight, Thomas
    Al-Sayed, Tamer
    Cooksley, Timothy J
    Affiliation
    Department of Acute Medicine and Critical Care, The Christie, Manchester
    Issue Date
    2019
    
    Metadata
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    Abstract
    BACKGROUND: Emergency patient presentations with febrile neutropenia are a heterogeneous group. A small minority of these patients proceed to develop significant medical complications. Risk stratification using scores, such as the Multinational Association for Supportive Care in Cancer score, have been advocated to identify patients who are at low risk of adverse outcome suitable for treatment on an ambulatory care pathway. OBJECTIVES: We sought to report the experience of 100 patients presenting acutely with neutropenic fever managed in an emergency ambulatory fashion. METHODS: Patients presenting as an emergency with low-risk febrile neutropenia managed in an ambulatory setting between January 2017 and February 2019 at a tertiary cancer hospital in England were prospectively studied. Patients with a fever >38.0¡C and an absolute neutrophil count <1.0 ? 109/L were included. All patients with a Multinational Association for Supportive Care in Cancer score ³21 and a National Early Warning Score ²3 were potentially eligible for the pathway. Complications were classified as serious if the patient developed persistent hypotension, respiratory failure, intensive care unit admission, altered mental status, disseminated intravascular coagulation, renal failure requiring renal replacement therapy, electrocardiogram changes requiring antidysrhythmic treatment, and 30-day mortality. RESULTS: One hundred patients with low-risk febrile neutropenia consecutively managed in an emergency ambulatory fashion were prospectively analyzed. Eighty-one patients were female and the median age was 51 y (range 17-79 y). No patients developed serious complications. Eight (8% [95% confidence interval 4.1-15.0%]) patients had a 7-day readmission. CONCLUSION: Outpatient ambulatory care for emergency patients with low-risk febrile neutropenia can be delivered in a safe and effective fashion. Collaboration between acute care physicians and oncologists is required to develop local models based on national guidelines to facilitate individualised care for emergency oncology patients.
    Citation
    Marshall W, Campbell G, Knight T, Al-Sayed T, Cooksley T. Emergency Ambulatory Management of Low-Risk Febrile Neutropenia: Multinational Association for Supportive Care in Cancer Fits-Real-World Experience From a UK Cancer Center. J Emerg Med. 2019:S4679.
    Journal
    Journal of emergency medicine
    URI
    http://hdl.handle.net/10541/622644
    DOI
    10.1016/j.jemermed.2019.09.032
    PubMed ID
    31744709
    Additional Links
    https://dx.doi.org/10.1016/j.jemermed.2019.09.032
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jemermed.2019.09.032
    Scopus Count
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