title: Emergency Department evaluation of patients with fever and chemotherapy-induced neutropenia.
abstract: We sought to describe the common causes of infection in patients presenting to the Emergency Department (ED) with elevated temperature and chemotherapy-induced neutropenia and to determine the frequency with which the ED diagnosis of infection is consistent with the final hospital discharge diagnosis. We performed a structured restrospective chart review of ED patients with fever (T > 38 degrees C) and neutropenia (absolute neutrophil count < 1000/mm(3)) over a 2-year period. Fifty-five episodes of neutropenic fever occurred in 52 patients (mean age 52 years, range 18-86 years; 53% men). Twenty-six patients (47%) were found to have a specific infection identified. Of these, 21/26 (81%; 95% CI, 70-91%) had the source of infection identified while in the ED. All patients who had a focal site of infection identified during their hospitalization were diagnosed in the ED (100%; 95% CI, 86-100%). The other 5 patients, without a source identified in the ED, were found to have bacteremia. The 29 patients without a source identified in the ED were hospitalized and had negative blood and urine cultures and were discharged to home after resolution of fever. A thorough history, physical examination, chest radiograph and urinalysis in the ED identified all patients with a focus of infection. Meticulous ED evaluation of patients with neutropenia and fever may be sufficient to diagnose most sources of infection; however, a significant number of patients without an identifiable focus may have bacteremia.
authors.affiliation: Division of Toxicology, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Jeanmarie
authors.initials: J
authors.lastname: Perrone
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Datner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D016470:Bacteremia / Q000150:complications / Q000175:diagnosis / Q000276:immunology; D004632:Emergency Medical Services; D005260:Female; D005334:Fever / Q000209:etiology* / Q000276:immunology; D006784:Hospitals, Teaching; D006801:Humans; D016867:Immunocompromised Host; D007239:Infections / Q000150:complications / Q000175:diagnosis / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced* / Q000276:immunology; D010414:Pennsylvania; D012189:Retrospective Studies; D013997:Time Factors; D014505:Urban Population
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents