Application of the MASCC and CISNE Risk-Stratification Scores to Identify Low-Risk Febrile Neutropenic Patients in the Emergency Department

Abstract

Our results suggest that the CISNE score may be the most appropriate febrile neutropenia risk-stratification tool for use in the ED.

Antibiotic prescribing and outcomes in cancer patients with febrile neutropenia in the emergency department

“…https://doi.org/10.1371/journal.pone.0229828.g002 patients with febrile neutropenia in the emergency setting [12]. In this study, 16% of the lowrisk patients had complications.…”

“…Very few tools exist to risk-stratify neutropenic patients and the Multinational Association of Supportive Care in Cancer (MASCC) risk-index is one of them [11]. This tool is widely used in the oncology field and is recommended by international guidelines [8] but has shown some limits in the emergency setting [12]. With this study performed in the ED, we aimed to investigate the effect of antibiotic timing and appropriateness on outcomes in patients with febrile neutropenia and to assess the performance of the MASCC risk-index in risk-stratifying such patients in the ED.…”

Can Neutropenic Fever Ever Be Low Risk?

“…We are obviously confident of the traditional management: broad-spectrum antibiotics, source identification, and admission. 1,2 But what if we told you there was some subtlety in the evaluation of neutropenic fever, some gray area, some evidence that there might be another way? It turns out that these well-appearing patients without signs of end-organ dysfunction may be at low risk for serious complications.…”

“…It turns out that these well-appearing patients without signs of end-organ dysfunction may be at low risk for serious complications. [2][3][4] In fact, in the ambulatory hematology-oncology setting, these low-risk patients, identified by risk-stratification indices such as the Multinational Association for Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) scores, are sent home with oral antibiotics. 3,4 These risk-stratification tools, however, have yet to be applied to the ED.until now.…”

“…In this article by Coyne et al, 2 the authors retrospectively apply these risk-stratification scores to a cohort of febrile, neutropenic ED patients and review adverse outcome rates across the various risk groups.…”