Safety and effectiveness of outpatient therapy in 596 low-risk patients with febrile neutropenia (FN)

2005 ◽  
Vol 23 (16_suppl) ◽  
pp. 8116-8116
Author(s):  
L. Elting ◽  
C. Lu ◽  
C. Escalante ◽  
S. Giordano ◽  
J. Trent ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Low Risk ◽  
Outpatient Therapy ◽  
Risk Patients

Outcomes and Cost of Outpatient or Inpatient Management of 712 Patients With Febrile Neutropenia

2008 ◽  
Vol 26 (4) ◽  
pp. 606-611 ◽  
Author(s):  
Linda S. Elting ◽  
Charles Lu ◽  
Carmelita P. Escalante ◽  
Sharon H. Giordano ◽  
Jonathan C. Trent ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Statistical Tests ◽  
Signs And Symptoms ◽  
Low Risk ◽  
Outpatient Management ◽  
Single Episode ◽  
Risk Patients ◽  
Inpatient Management ◽  
The Mean ◽  
Mean Cost

Purpose We retrospectively compared the outcomes and costs of outpatient and inpatient management of low-risk outpatients who presented to an emergency department with febrile neutropenia (FN). Patients and Methods A single episode of FN was randomly chosen from each of 712 consecutive, low-risk solid tumor outpatients who had been treated prospectively on a clinical pathway (1997-2003). Their medical records were reviewed retrospectively for overall success (resolution of all signs and symptoms of infection without modification of antibiotics, major medical complications, or intensive care unit admission) and nine secondary outcomes. Outcomes were assessed by physician investigators who were blinded to management strategy. Outcomes and costs (payer's perspective) in 529 low-risk outpatients were compared with 123 low-risk patients who were psychosocially ineligible for outpatient management (no access to caregiver, telephone, or transportation; residence > 30 minutes from treating center; poor compliance with previous outpatient therapy) using univariate statistical tests. Results Overall success was 80% among low-risk outpatients and 79% among low-risk inpatients. Response to initial antibiotics was 81% among outpatients and 80% among inpatients (P = .94); 21% of those initially treated as outpatients subsequently required hospitalization. All patients ultimately responded to antibiotics; there were no deaths. Serious complications were rare (1%) and equally frequent between the groups. The mean cost of therapy among inpatients was double that of outpatients ($15,231 v $7,772; P < .001). Conclusion Outpatient management of low-risk patients with FN is as safe and effective as inpatient management of low-risk patients and is significantly less costly.

Predictive factors of bacteraemia in low-risk patients with febrile neutropenia

2011 ◽  
Vol 29 (9) ◽  
pp. 715-719 ◽  
Author(s):  
Shin Ahn ◽  
Yoon-Seon Lee ◽  
Yeon Hee Chun ◽  
Kyung Soo Lim ◽  
Won Kim ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Predictive Factors ◽  
Low Risk ◽  
Risk Patients

scholarly journals Ambulatory Outpatient Management of patients with low risk febrile neutropaenia

2015 ◽  
Vol 14 (4) ◽  
pp. 178-181
Author(s):  
Timothy Cooksley ◽  
◽  
Mark Holland ◽  
Jean Klastersky ◽  
◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Cost Savings ◽  
Scoring Systems ◽  
Low Risk ◽  
Ambulatory Setting ◽  
Medical Complications ◽  
Mascc Score ◽  
Risk Patients ◽  
Reduced Risk ◽  
Avoidance Cost

Patients with febrile neutropenia are a heterogeneous group with only a minority developing significant medical complications. Scoring systems, such as the Multinational Association for Supportive Care in Cancer (MASCC) score, have been developed and validated to identify low risk patients. Caring for patients with low risk febrile neutropenia in an ambulatory setting is proven to be safe and effective. Benefits include admission avoidance, cost savings and reduced risk of nosocomial infections, as well as improved patient experience and satisfaction. Implementation of an ambulatory pathway for low risk febrile neutropenia provides an excellent opportunity for Acute Physicians and Oncologists to collaborate in delivering care for this group of patients.

scholarly journals Internal evaluation of risk stratification tool using procalcitonin and clinical risk factors in pediatric febrile neutropenia: the first step in a pilot quality improvement project

2021 ◽  
Author(s):  
Charles Nessle ◽  
Thomas Braun ◽  
Sung Won Choi ◽  
Rajen Mody
Keyword(s):  
Febrile Neutropenia ◽  
Risk Stratification ◽  
Bacterial Infections ◽  
Decision Rules ◽  
Clinical Decision ◽  
Blood Stream ◽  
Low Risk ◽  
Improvement Project ◽  
Internal Evaluation ◽  
Risk Patients

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.

Identification of Low-Risk Patients with Acute Symptomatic Pulmonary Embolism for Outpatient Therapy

2015 ◽  
pp. 150626095350002 ◽  
Author(s):  
Ana Maestre ◽  
Javier Trujillo-Santos ◽  
Antoni Riera-Mestre ◽  
David Jiménez ◽  
Pierpaolo Di Micco ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Low Risk ◽  
Outpatient Therapy ◽  
Symptomatic Pulmonary Embolism ◽  
Risk Patients

scholarly journals Emperical Oral Antibiotic Therapy for Children with Low Risk Febrile Neutropenia during Cancer Chemotherapy

1970 ◽  
Vol 29 (1) ◽  
pp. 22-25 ◽  
Author(s):  
PN Shrestha ◽  
K Sah ◽  
R Rana
Keyword(s):  
Febrile Neutropenia ◽  
Cancer Chemotherapy ◽  
Empirical Therapy ◽  
Low Risk ◽  
Oral Antibiotic ◽  
Oral Antibiotics ◽  
Safe Alternative ◽  
Oral Antibiotic Therapy ◽  
Intravenous Antibiotics ◽  
Risk Patients

Introduction: In patient with fever and neutropenia during cancer chemotherapy who have a low risk of complications, oral antibiotic may be an acceptable alternative to intravenous antibiotics. Methods: We conducted a prospective hospital based study to the patients who had fever and neutropenia during caner chemotherapy. Only low risk patients i.e. neutropenia of less than seven days, ANC >250/cmm, without any signs of shock were included in the study. All the patients were hospitalized and given oral antibiotics Ofloxacin and Amoxy-Clav and were closely observed until fever subsided for more than 48 hours and improved from neutropenia. Results: A total of 54 cases were enrolled in the study. Out of 54 patients two patients were lost, 8 needed IV antibiotics for different reasons and 44 patients (81%) improved well with oral antibiotics only. Conclusion: In hospitalized low risk patients who have fever and neutropenia, empirical therapy with oral ofloxacin and amoxy-clav may be a safe alternative to IV antibiotics. Key words: Febrile Neutropenia, Cancer Chemotherapy, ANC.   doi:10.3126/jnps.v29i1.1596 J. Nepal Paediatr. Soc. Vol.29(1) p.22-25   

scholarly journals Safety of Early Discharge for Low-Risk Patients With Febrile Neutropenia: A Multicenter Randomized Controlled Trial

2011 ◽  
Vol 29 (30) ◽  
pp. 3977-3983 ◽  
Author(s):  
James A. Talcott ◽  
Beow Y. Yeap ◽  
Jack A. Clark ◽  
Robert D. Siegel ◽  
Elizabeth Trice Loggers ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Early Discharge ◽  
Low Risk ◽  
Clinical Deterioration ◽  
Patient Comfort ◽  
Study Patient ◽  
Medical Attention ◽  
Multicenter Randomized Controlled Trial ◽  
Patient Reported ◽  
Risk Patients

PurposeFebrile neutropenia commonly complicates cancer chemotherapy. Outpatient treatment may reduce costs and improve patient comfort but risk progression of undetected medical problems.Patients and MethodsBy using our validated algorithm, we identified medically stable inpatients admitted for febrile neutropenia (neutrophils < 500/μL) after chemotherapy and randomly assigned them to continued inpatient antibiotic therapy or early discharge to receive identical antibiotic treatment at home. Our primary outcome was the occurrence of any serious medical complication, defined as evidence of medical instability requiring urgent medical attention.ResultsWe enrolled 117 patients with 121 febrile neutropenia episodes before study termination for poor accrual. We excluded five episodes as ineligible and three because of inadequate documentation of the study outcome. Treatment groups were clinically similar, but sociodemographic imbalances occurred because of block randomization. The median presenting absolute neutrophil count was 100/μL. Hematopoietic growth factors were used in 38% of episodes. The median neutropenia duration was 4 days (range, 1 to 15 days). Five outpatients were readmitted to the hospital. Major medical complications occurred in five episodes (8%) in the hospital arm and four (9%) in the home arm (95% CI for the difference, −10% to 13%; P = .56). No study patient died. Patient-reported quality of life was similar on both arms.ConclusionWe found no evidence of adverse medical consequences from home care, despite a protocol designed to detect evidence of clinical deterioration. These results should reassure clinicians who elect to treat rigorously characterized low-risk patients with febrile neutropenia in suitable outpatient settings with appropriate surveillance for unexpected clinical deterioration.

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