Can I go home now? The safety and efficacy of a new UK paediatric febrile neutropenia protocol for risk-stratified early discharge on oral antibiotics

TY - JOUR

T1 - Can I go home now?

T2 - The safety and efficacy of a new UK paediatric febrile neutropenia protocol for risk-stratified early discharge on oral antibiotics

AU - Jackson, Thomas John

AU - Napper, Rachel

AU - Haeusler, Gabrielle M

AU - Pizer, Barry

AU - Bate, Jessica

AU - Grundy, Richard G

AU - Samarasinghe, Sujith

AU - Angelini, Paola

AU - Ball-Gamble, Ashley

AU - Phillips, Bob

AU - Morgan, Jessica Elizabeth

N1 - © Author(s) (or their employer(s)) 2023

PY - 2022/12/12

Y1 - 2022/12/12

N2 - OBJECTIVE: To evaluate a new protocol of risk stratification and early discharge for children with febrile neutropenia (FN).DESIGN: Prospective service evaluation from 17 April 2020 to 16 April 2021.SETTING: 13 specialist centres in the UK.PATIENTS: 405 children presenting with FN.INTERVENTION: All children received intravenous antibiotics at presentation. Risk stratification was determined using the Australian-UK-Swiss (AUS) rule and eligibility for homecare assessed using criteria including disease, chemotherapy, presenting features and social factors. Those eligible for homecare could be discharged on oral antibiotics after a period of observation proportional to their risk group.MAIN OUTCOME MEASURES: Median duration of admission and of intravenous antibiotics, and percentage of patients with positive blood cultures, significant infection, readmission within 7 days of initial presentation, intensive care unit (ICU) admission, death from infection and death from other causes.RESULTS: 13 centres contributed 729 initial presentations of 405 patients. AUS rule scores were positively correlated with positive blood cultures, significant infection, ICU admission and death. 20% of children were eligible for homecare with oral antibiotics, of which 55% were low risk (AUS 0-1). 46% low-risk homecare eligible patients were discharged by 24 hours vs 2% homecare ineligible. Homecare readmission rates were 14% overall and 16% for low-risk cases (similar to a meta-analysis of previous studies). No child eligible for homecare was admitted to ICU or died.CONCLUSIONS: Use of the AUS rule and homecare criteria allow for safe early outpatient management of children with FN.

AB - OBJECTIVE: To evaluate a new protocol of risk stratification and early discharge for children with febrile neutropenia (FN).DESIGN: Prospective service evaluation from 17 April 2020 to 16 April 2021.SETTING: 13 specialist centres in the UK.PATIENTS: 405 children presenting with FN.INTERVENTION: All children received intravenous antibiotics at presentation. Risk stratification was determined using the Australian-UK-Swiss (AUS) rule and eligibility for homecare assessed using criteria including disease, chemotherapy, presenting features and social factors. Those eligible for homecare could be discharged on oral antibiotics after a period of observation proportional to their risk group.MAIN OUTCOME MEASURES: Median duration of admission and of intravenous antibiotics, and percentage of patients with positive blood cultures, significant infection, readmission within 7 days of initial presentation, intensive care unit (ICU) admission, death from infection and death from other causes.RESULTS: 13 centres contributed 729 initial presentations of 405 patients. AUS rule scores were positively correlated with positive blood cultures, significant infection, ICU admission and death. 20% of children were eligible for homecare with oral antibiotics, of which 55% were low risk (AUS 0-1). 46% low-risk homecare eligible patients were discharged by 24 hours vs 2% homecare ineligible. Homecare readmission rates were 14% overall and 16% for low-risk cases (similar to a meta-analysis of previous studies). No child eligible for homecare was admitted to ICU or died.CONCLUSIONS: Use of the AUS rule and homecare criteria allow for safe early outpatient management of children with FN.

U2 - 10.1136/archdischild-2021-323254

DO - 10.1136/archdischild-2021-323254

M3 - Article

C2 - 36600323

SN - 0003-9888

JO - Archives of Disease in Childhood

JF - Archives of Disease in Childhood

M1 - 323254

ER -