The following is a summary of the “Can Risk Stratification Tools Be Utilized to Safely Discharge Low-Risk Febrile Neutropenic Patients from the Emergency Department?,” published in the January 2023 issue of Emergency Medicine by Chen, et al.

One of the most common oncological emergencies is febrile neutropenia (FN), caused by chemotherapy. Most patients with FN who present to the ED are admitted, despite evidence in the oncology literature suggesting that low-risk cases of FN can be managed safely at home. Disposition decisions may benefit from using risk stratification tools for FN, such as the Multinational Association for Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) scores. 

They aimed to determine if there is sufficient evidence to recommend these strategies for treating patients with FN in the emergency department. The terms “febrile neutropenia” OR (fever AND neutropenia)) AND (emerg* OR outpatient) AND (March 19, 2021) were used to conduct a PubMed search covering the time period from January 1, 2016, through March 19, 2021. (admit OR admission OR hospitalization). We didn’t include any systematic reviews or case reports. Select articles were evaluated using a predetermined rubric.

After the authors independently checked the search results for relevance, 23 articles were chosen for inclusion, and around 10 of the studies that were found to use the MASCC score also concluded that it was helpful in the ED. The sensitivity of the CISNE score was higher than that of the MASCC score (96.7% vs. 32.9%), but the specificity was lower (22.2% vs. 89.5%) in most studies. There is evidence to suggest that using a risk stratification tool for FN, such as the MASCC or CISNE score, can help guide treatment decisions.

Source: sciencedirect.com/science/article/abs/pii/S0736467922005807