Could fever/neutropenia be low risk?
As our thinking evolves regarding febrile and neutropenic patients, which risk stratification score is best, MASCC or CISNE (check these out on MDCalc)? In this retrospective study of 230 febrile and neutropenic patients (defined as <1000 absolute neutrophil count, ANC) with all types of cancer, the CISNE score was 98.3% specific in identifying low risk patients. The MASCC score was only 54.2% specific. The gold standard for comparison was clinical outcome, which was determined a priori as a "negative outcome" or "no negative outcome" and consisted of organ failure, hypotension, upgrade in care, etc. Bear in mind, this has not been propspectively validated. But moving forward, look for more of the CISNE score and avoidance of admission in some patients with fever and neutropenia. Of course, this always warrants a discussion with the patient's oncologist. We aren't there yet with this study, but this is coming. Sending select patients with fever and neutropenia home is the future. We need to be experts on these scoring systems to make informed decisions for our patients.
The CISNE score beat the MASCC score for determining which patients with fever and neutropenia may be safe for outpatient management.
Application of the MASCC and CISNE Risk-Stratification Scores to Identify Low-Risk Febrile Neutropenic Patients in the Emergency Department. Ann Emerg Med. 2017 Jun;69(6):755-764. doi: 10.1016/j.annemergmed.2016.11.007. Epub 2016 Dec 29.
Peer reviewed by Thomas Davis.