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
- Author(s)
- Jackson, TJ; Napper, R; Haeusler, GM; Pizer, B; Bate, J; Grundy, RG; Samarasinghe, S; Angelini, P; Ball-Gamble, A; Phillips, B; Morgan, JE;
- Details
- Publication Year 2023-03,Volume 108,Issue #3,Page 192-197
- Journal Title
- Archives of Disease in Childhood
- Publication Type
- Research article
- Abstract
- 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.
- Publisher
- BMJ
- Keywords
- Child; Humans; Anti-Bacterial Agents/adverse effects; Patient Discharge; Prospective Studies; Australia/epidemiology; *Febrile Neutropenia; United Kingdom; *Neoplasms/drug therapy; Meta-Analysis as Topic; infectious disease medicine; paediatrics
- Department(s)
- Infectious Diseases
- PubMed ID
- 36600323
- Publisher's Version
- https://doi.org/10.1136/archdischild-2021-323254
- Open Access at Publisher's Site
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Creation Date: 2023-06-27 07:58:58
Last Modified: 2023-06-27 07:59:22