Castagnola et al identified a patient with febrile neutropenia at low risk for medical complications based on the presence of certain clinical factors. These can help identify a patient who can be managed conservatively.
Parameters:
(1) age
(2) major medical complications
(3) outpatient status
(4) indwelling central venous catheter
(5) ability to travel
(6) pain or mucositis
(7) underlying disease
(8) clinical infection
(9) infection of central venous catheter
(10) C-reactive protein
(11) duration of neutropenia and WBC count
(12) degree of anemia
(13) platelet count
(14) history of being followed as outpatient
(15) living arrangements
(16) working telephone at home
(17) distance to hospital
|
Parameter |
Finding |
Points |
|
age |
<= 1 year of age |
0 |
|
|
2 to 64 years of age |
1 |
|
|
>= 65 years of age |
0 |
|
major medical complications |
none |
1 |
|
|
present |
0 |
|
outpatient status |
outpatient for >= 48 hours prior to onset of fever |
1 |
|
|
other |
0 |
|
indwelling central venous catheter |
functional |
1 |
|
|
nonfunctional |
0 |
|
ability to travel |
not too sick to travel |
1 |
|
|
too sick to travel |
0 |
|
pain or mucositis |
absent |
1 |
|
|
mild pain or mucositis |
1 |
|
|
severe pain or mucositis |
0 |
|
underlying disease |
known and controlled |
1 |
|
|
uncertain |
0 |
|
|
known but not controlled |
0 |
|
clinical infection |
pneumonia, sepsis and/or CNS infection |
0 |
|
|
absent |
1 |
|
infection of central venous catheter |
absent |
1 |
|
|
present |
0 |
|
C-reactive protein |
normal or low levels |
1 |
|
|
high levels |
0 |
|
duration of neutropenia and WBC count |
short duration expected and WBC count > 100 per µL |
1 |
|
|
other |
0 |
|
degree of anemia |
none or mild |
1 |
|
|
moderate or severe |
0 |
|
platelet count |
> 75,000 per µL and increasing within past 24 hours |
1 |
|
|
other |
0 |
|
history of being followed as an outpatient |
none |
0 |
|
|
present |
1 |
|
living arrangements |
living alone |
0 |
|
|
unattended part of day |
0 |
|
|
not living alone and caregiver present at all times |
1 |
|
working telephone in home |
present |
1 |
|
|
absent |
0 |
|
distance from hospital |
drive <= 1 hour |
1 |
|
|
drive > 1 hour |
0 |
where:
• I am not sure if a child 13 to 24 months of age would fall into the low risk group.
• I am not sure how a patient without an indwelling central venous catheter would be scored, especially if a functional line could be started.
• Although the table refers to the WBC count as being > 100 per µL, I think this refers to the absolute neutrophil count.
number of low risk features =
= SUM(points for all 17 parameters)
Interpretation:
• minimum number: 0
• maximum number: 17
• A patient with all 17 low risk factors should be at low risk for medical complications.
Specialty: Infectious Diseases, Hematology Oncology
