title: Early discharge of low-risk febrile neutropenic children and adolescents with cancer.
abstract: During the past decade, a relatively lower-risk patient population of febrile neutropenic children with cancer (over one-half of all these patients) has been identified. These patients can be safely discharged from the hospital before their absolute neutrophil count (ANC) exceeds 500/mm3. To evaluate the practice of early discharge of these patients, 580 consecutive episodes of chemotherapy-induced febrile neutropenia in 253 children and adolescents with cancer between June 1992 and May 1995 were reviewed. Three hundred thirty episodes ended in discharge before the patient's ANC was > 500/mm3. Patients were characterized as being at relatively lower risk if they had sterile blood cultures, were afebrile for > 24 hours, appeared well, and were thought to have evidence of marrow recovery. Of the 330 episodes, only 21 (6%) were associated with admission for recurrent fever during the subsequent 7 days. In retrospect, in only six of these 21 cases of readmission (or 2% of 330 episodes) was there evidence of bone marrow recovery, and none of the blood cultures were positive during the subsequent hospitalization. All patients who met low-risk criteria fared well during their second hospitalization. This early discharge strategy was safe and resulted in substantial cost savings.
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas 75235-9063, USA.
authors.forename: V M
authors.initials: VM
authors.lastname: Aquino
authors.forename: I
authors.initials: I
authors.lastname: Tkaczewski
authors.forename: G R
authors.initials: GR
authors.lastname: Buchanan
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D009369:Neoplasms / Q000188:drug therapy / Q000503:physiopathology*; D009503:Neutropenia / Q000139:chemically induced / Q000503:physiopathology* / Q000628:therapy; D009504:Neutrophils; D010351:Patient Discharge; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors